How to be thankful

There is one thing that makes us unique, able to rise upon the rift between the right and left and remind us daily what we have to be grateful for. I can put it into one word.

Don't be like 'The Walking Dead'

Sometimes we get so bogged down in what we are doing that we forget why we were doing it in the first place. Unfortunately, my favorite TV show doesn't seem to realize this. Don't do the same.

Documentation is like cotton candy

Very often, the nursing progress note documentation is like cotton candy. You think it looks really good but when you get down to it, it's just a sticky mess! Or, just a bunch of fluff with no substance. Electronic medical records systems often compound this issue.

Autonomy and risky business

Let's face it, nursing home culture change and honoring resident choice can still bring about an anxiety attack to the most laid back of nurses. Promoting resident autonomy without exposing providers to a risk of liability is kind of an oxymoron. But we've all heard it: "No risk, no reward."

Pondering oddities of the job, and more

I have to say that I absolutely love working in eldercare. I mean, I thought I would have to move down South if I wanted to say whatever was on my mind.

No Rhyme or Reason

Did you know that September 1 was "No Rhyme or Reason Day"? Apparently, there is a day to celebrate words that don't rhyme and things that don't make sense. This gets me thinking about, well, things that go on in our facilities because people don't think.

A nurse's 'Ode to a Care Plan'

Oh, canned core care plans, I so despise you! There's no way I can personalize you!

7 habits of highly successful nurses

There's a thing or two new nurses can learn from us "veterans." Those of us who make it to veteran status tend to share some common habits. Let me break them down for you.

You can't keep a good nurse down

Alice Graber started during World War II and kept at it until last month. Now, the retired nurse is going to volunteer at ... well, you're not going to believe it.

Discharge instructions may equal confusion

Written discharge instructions shouldn't be our only source of discharge education. I am a big fan of the teach-back method. That way you can be sure if your patient really understands the instructions and responsibilities.

Independence Day — for all

Yes, July 4th is right around the corner. Time to think of backyard barbecues, fireworks, blockbuster movies and ... §483.25 — Quality of Care.

Time to end the Dickey Amendment — for good!

The Orlando mass shootings and killings last weekend have brought out the absurdity again: Research on gun safety and violence by the Centers for Disease Control and Prevention has been halted for years. This insanity has to stop.

Keep up with the population

When people ask me how I take my coffee, my answer is "Seriously, very seriously!" This is no joke. Just ask my well-trained (and very tolerant) husband, who knows to avoid me until I have had my first cup.

What's in a name? ... Adding insult to ulcer

Names have the ability to impact us in ways we may not imagine. What strongly comes to mind is the unintended consequences of the updated pressure ulcer staging recently released from the National Pressure Ulcer Advisory Panel.

Time again for the most imaginative call-out excuse

It's time again for the nearly annual "most imaginative reason to call-out" blog. What is the most imaginative call-out you have ever received by somebody wanting to take a day off work? We've heard some wild ones.

Commanding respect from the disrespectful

I started my nursing career in a very busy teaching-hospital operating room. I loved the excitement, the anticipation of the surgeon's needs. But what I didn't love was the utter disrespect many of the surgeons had for the nursing staff.

A right of passage or a risk of passing?

When I die, I want to go like my grandmother, peacefully in her sleep ... not like the three passengers screaming in the back seat of her Buick! (OK, old joke). But what isn't a joke is elders with cognitive impairment and safe driving.

Planning for the unplanned: They ARE eventually going to leave!

OK, in the title I'm not talking about your proverbial brother-in-law who is staying on the couch, or your college-graduated kids ... because we all know they're NEVER leave going to leave. I'm talking about your residents.

What I wish I knew back then

I saw a question on LinkedIn asking you to think back to your first job and what you wish you knew back then that you know now. It really got me thinking. After pondering on it for a while, my answer is ... "nothing."

Poisonous dining experience legal?

In our long-term care and senior care world, we get tagged if our residents' dining experience simply does not meet their expectations. But apparently, there is a federal loophole that allows poisons in our foods.

America's finest people

Here we are again, with another record-breaking snowstorm ... when the word SNOW is a four-letter word and just hearing it brings many of us to our knees (often to throw up in a panic in the bathroom!)

Profit over public health — again

With a lot of controversy, the 2016 Dietary Guidelines have just been published. Unfortunately, they constitute a slap in the face to the brilliant and hardworking 2015 Dietary Guidelines Advisory Committee (DGAC).

'Twas the week after Christmas ...

'Twas the week after Christmas, just leaving the home. I steered for my latte, light on the foam. The traffic was tough, so I drove with great care — in hopes my caffeine-fix soon would be there.

The 'Icky' Dickey Amendment — our problem with gun nuts

I have a riddle for you. How many young adults are in long-term care facilities because of gun violence? The answer: No one knows because there is a ban restricting federal funding for gun violence research. It's ridiculous.

Not going to say that any more

With Thanksgiving just past, I realize how thankful I am that certain people and situations have helped me adjust my attitude at various times. I'm talking differently, and I definitely have changed my outlook on life this year. Let me explain.

No stopping me from bringing home the bacon

One thing you can say about working in long-term care is that as long as the population keeps aging, we're pretty much guaranteed to be able to find a job. Yep, we can keep bringing home that bacon. Notice we don't say "bringing home the salad" for a reason.

Rudeness kills -- like, literally

Maybe a blog about killing your patients right after Halloween is an appropriate topic. After all, that would make a pretty scary movie, right? But this isn't some scary movie. It's true.

A vampire walks into an ER ...

Since Halloween is just around the corner, I thought this story is apropos. Especially since most nurses don't question the situations that walk into our workspace. At all.

TSA screening could lead to colonoscopy

With all the fall healthcare conferences and other things we travel for this time of year, you might want to pay special attention to this blog!

Boo 'The View'

If anyone has learned anything about live television talk shows, it's this: DO NOT mess with nurses! The View's insulting mockery of Miss Colorado's Kelley Johnson's monologue kicked off a firestorm of a backlash on social media this week.

Labor Day, and remembering

So we just had Labor Day, a time when most of the country gets a three-day weekend and forgets that many of those in service jobs don't have that luxury.

Think before you open your mouth in court!

Unfortunately, in this litigious society, and especially as long-term care professionals, we are sometimes put in a position to open our mouths in court. If you worry about this, relax. You can't do any worse some others before you.

A picture (or a sign) says a thousand words

We always have a lot of signs in our facilities, right? Well, yesterday I came across a new one that blew my mind. I asked the driver of the car I was in to stop so I could take a picture of it.

Dorothy, we're not in Florida any more

Florida and Arizona, and other similar warm weather destinations, might no longer be the prize places retirees wish to spend their golden years. And the reason might surprise you.

It's not complicated

I can't stand TV shows that do a poor job of portraying nurses or the medical profession. Unfortunately, I just found another one. Let me save you from it.

Ode to ICD-10

Oh, ICD-10, you are so near, Your extra digits is what we fear. We have to start on October One, But coding drafts are still undone!

Preparing nurses to respond to disaster — including some you've never thought of

Nurses are trained in so many ways to prepare for disasters. But there are some "disasters" we haven't planned for. Take, for instance, when the registered dietician decides to create a vegetarian-based recipe of a tofu and bean casserole for dinner — and doesn't tell you.

10 things a boss shouldn't say

I recently read an article that discussed the Top 10 sentences a manager or boss should never let past their lips. You should think, "Run for the hills!" if they say any of these things. And yet they do. Here's my Real Nurse Jackie take on them.

Leave the cape at home to become a caregiving hero

OK, let's face it. We all have an inner superhero in us or we wouldn't be in the business of serving. But sometimes we need to leave that cape at home.

Clean your own house

It was recently announced that U.S. Drug Enforcement Administration agents allegedly had repeated "sex parties" with prostitutes at events sponsored by none other than drug cartels themselves. And these are the guys who say they can't trust US?

Death by Acronym

With apologies to Dr. Seuss, let me begin: I do not like these acronyms, these baffling lettered synonyms ...

Oh no, they didn't! More document nightmares

As I've mentioned before, I believe nursing documentation is the bane of any nursing director's existence. Frankly, I think the look on my face when opening a medical record to the nurse's note section is exactly the same face I make when opening the stall to a public toilet. In other words, I never know what I'll find, and I'm prepared for something scary!

If we are supposed to follow our dreams, why can't I go back to bed?

You ever have one of those days, weeks or even months when things just don't go your way? In other words, life is just lousy and no matter what you do, it still just stinks? This is what you need to do.

LTC Evangelism 101

Do you ever try to attract "talent" to your work environment? Sometimes I'm surprised we recruit at all. I know most people fall in love once they get there, but the getting there is the key.

Nurse, will you hear me?

There was a recent New York Times op-ed piece titled "Doctor, Shut Up and Listen." Basically, it took you through a case about a woman who was having symptoms of a rapid heartbeat and feeling "stressed." However, every doctor she saw wrongly referred her for psychological counseling for an anxiety disorder.

C'mon, be reasonable: Goals for the new year

Well gang, it's a new year and the time where we set sparkly, brand spanking new goals. Most of the world sets goals such as losing weight, getting in shape, setting their finances in order and things like that. But no matter what the goal, the trick is to be reasonable.

We all need to breathe

Recently, I was at an event where the Pledge of Allegiance was said and started to really concentrate on the words. I asked myself: Are we really one nation, with liberty and justice for all? Why is it so important we ask ourselves this? Because our facilities really are the most diverse workplaces I know.

With age comes wisdom ... and a sense of humor

Anyone who knows me well knows I idolize my dad. He's taught me so much that there is no way I could quantify it all. And even at age 90, he's still teaching a lot, I'm noticing.

Most creative excuses given not to work

Every year I like to ask: What do you feel is the most imaginative call-out you received this past year? We're totally into interactive blogging, so please note yours below. We had some doozies when I asked this before. Check out some I've heard recently.

The schizophrenia of patient-centered care

Is it me or sometimes do the wide interpretations within the State Operations Manual (the dreaded "RED book") make you want to question your entire existence? I mean, we've been working so diligently toward Culture Change and the true meaning of person-centered care. Nationally, I thought we were making headway. But nooooooo.

Bed A and Bed B are people!

As a Charlton Heston movie once illustrated in an indirect way, it's important to know about the lives of who is living in our home. It's about relationships, not about heads in the beds.

The Walking (Half-) Dead

OK, I'll admit it. I am a huge fan of the AMC show, "The Walking Dead," which incidentally had a blockbuster Season 5 premier Sunday. It's really bizarre because I am a big weenie when it comes to scary movies. I can't even watch the previews for a horror movie on TV without hiding under a blanket.

A nurse invented that! (But most likely didn't get credit for it)

Nurses have invented some really cool stuff. But most likely they've received just pats on the heads for coming up with a "work-around" or a "creative solution." Then someone else slaps a patent on it and becomes the financial victor.

The fault in our (5) stars

So, let me start off by saying that I am sure a lot of us have our own rating systems. For example, my sisters and I have a tissue-box rating system for tearjerker books and movies. The book the "Fault in Our Stars" (excellent in my opinion) was a 5-tissue-box book. The movie "Terms of Endearment" a 5-tissue-box movie, for sure.

Why it really is the most wonderful time of the year

It's back to school time. For most of the world, figuring out childcare just got easier. But it isn't so easy when you have to be at work before school starts, or after it ends AND you're making the money a nursing assistant makes. Here's a possible solution.

If you want it, YOU have to make it happen!

A recent article on Medline Nursing alleged that the average registered nurse (RN) wants more sleep, authority respect and work-life balance. We can get what we want. We just have to learn to "ask" in the right way. And who should we ask? Well, mostly ourselves.

How old is too old to work?

A recent article in Health Affairs centered on nurses delaying retirement and claimed this is boosting the workforce. Should we believe this?

Just say NO — to giving in to patients

I'm just going to say it: Nurses in long-term care are really guilty when it comes to giving in to patients who want non-clinically necessary treatment. You know what I mean.

AAADD — Ack! Why you should arrange to be interrupted

OK can I just sound off a bit? I hate being interrupted multiple times throughout the day when it is just not necessary. I mean, I am at an age where I am seriously affected with AAAD (Age Associated Attention Deficit Disorder). It's hard enough to concentrate some days as it is, without constant interruptions that could have waited.

Ahhh, it's summer... (Run for your life!)

The birds are singing, everything is green, people are planning vacations and you are shaking in your boots. Because you know, unlike the rest of the world, that with your job, you're gonna have more patients to take care of than you can shake a stick at!

A blessing within the loss

This is a very hard blog for me to write. My mother just passed away. It was very sudden and not expected. I am blessed to have two mothers: A step-mother who has been in my life since I have been 8 years old (the nurse I often speak of and call "Mom") and "Mother" who just passed. But the reason I am writing this is not to garner sympathy or share my pain, but to share a rare experience that I think only those of us in healthcare may understand.

I was a better nurse when ...

It's Nurses Day — a day we celebrate all it means to be a nurse. This day gets me into deep thinking. Particularly about the core of a nurse and how sometimes — even if we don't want it to be — the environment we work in changes us. Let me try and explain.

Nurses Day — a picture of perseverance

As Nurses Day approaches, I've begun to wonder: How do you describe in one blog the "awesomeness" of a long-term care nurse? And then it hit me ... a single word. Perhaps no single word in the human language better describes the nurse in the long-term care continuum.

Spacely Sprockets and the future of medical care

So does anyone remember the cartoon "The Jetsons"? You know, George and Jane, daughter Judy, son Elroy and, of course, the dog, Astro. It's kind of fun to see how their 1960s and 1980s syndicated views of the futureare turning out. (I love Nick at Nite).

Sounding off on personal care alarms: Enough already

We all know how technology is supposed to help us. And for the most part, it does. But sometimes, too much of something isn't a good thing. I'm talking about personal care alarms. While they have become more sophisticated and more technical, we as human beings have not.

Nurses are tired of being tired

Nurses regret more than clinical decisions when they're too tired at work — and that happens all to often. Here's what we should do about it.

It was 55 degrees in Sochi while we were expecting Snowmageddon

This one is subtitled "Nursing facility personnel are essential and other things the world wasn't anticipating." Yes, while the temperature unexpectedly rose in Sochi, Russia, making winter sports precarious for many of the Olympic athletes, we on the East Coast and in other areas were having weather issues of our own. "Snow" is a four-letter word in its own right in the healthcare arena.

Puppy Bowl and bending it like Beckham

Let's face it: Sometimes life at work can be like the Denver Broncos at this year's Super Bowl. And if we let that get in the way, we're going to feel like Peyton Manning on his way to the locker room.

What's your load? How nurses can lighten med usage

The US Food and Drug Administration recently requested that practitioners stop prescribing combination prescription pain medications that have more than 325 mg of acetaminophen per tablet, capsule, etc., due to the risk of liver damage. This is a good thing.

Wishes for a Happy New Year — in their words and mine

Surfing the Internet around New Year's Day, I saw many quotes, both famous and anonymous, spreading wishes and advice for the year ahead. I thought of how, with some minor adjustments, they could apply to our lives, where we work and what we do. So, let's look at these and see how we, too, can enjoy a wonderful New Year.

Lost in Medicare Part D land

My mom called me to relay her "tragic" story of trying to sign up for a Medicare Part D plan. She hadn't signed up for one, and didn't feel that she needed one, but at lunch her girlfriends were discussing the pros and cons of their plans and asked Mom what plan she was on.

I pay dead people

On Oct. 31 (an ironic coincidence?) a report from the Office of inspector General frighteningly said Medicare paid some $23 million in benefits for more than 17,000 dead people in 2011. And my husband says I waste money.

Those crazy direct-to-consumer ads

OK, I have to admit it. Because I hate all things impractical I HATE those pharmaceutical direct-to-consumer advertisements. Oh, and every pharma rep I know hates them, too. I have a solution.

And the winners are ...

The Frontline Health Workers Coalition and Save the Children are launching the second annual REAL Awards, a very special awards program designed to develop respect and appreciation for health workers for the care they give in the United States and globally.

What's your view from the outside?

I bet a few of you are going to be thinking while you read this, "What has this got to do with a healthcare blog?" Give me a minute and you will see where I am going with it.You will see a lot, in fact.

When life gets in the way of life

You ever have one of those weeks that kind of runs into the weekend and then runs into the next week? And while you wanted to do your personal life "stuff" your work life "stuff" just doesn't let you? How about when this happens week, after week, after week? And why do we let this happen? Did we set the standard or did society?

I just love the news

Despite the economy, the price of gas and what is going on in Syria, it's all good news for me.

Look on the bright side to fight depression

I was recently reading an article about depression and what one can do to help themselves. It said that how you became depressed is important, but more importantly, you can learn how to do various things do defeat the depression. I can mostly "buy into" all the solutions, but I want to equate the answers to the work place.

Burnout equals HAIs and higher costs

A team of researchers at the University of Pennsylvania used a survey tool called the Maslach Burnout Inventory to analyse nurse burn out, or what they defined as a "burnout nurse". Now, if you ask, me, just look around any hospital or especially any nursing home and you don't need a survey tool to tell you that you're working your average nursing staff to death.

Give these nurses a hand, really

The American Nurses Association recently revealed national standards for safe patient handling and mobility. I say, "Bravo!" And it's about time.

Caring means remembering the 'who'

I have read two things that really got me thinking how it's imperative we have to know "who" our residents are. Not by disease or condition, but by their history.

The provider that doesn't read this risks getting capsized

Hey, long-term care operator, a sexy tidal wave is coming your way. It's going to change the way you do just about everything. Let me explain.

FDA — full of poop?

Every few days I read the Food and Drug Administration (FDA) news to see if there is anything relevant to eldercare that I should be aware of. Recently, I came across an extremely eye-opening item.

The bridge is here for your personal aging planning — cross it

A new poll* finds that two-thirds of people 40 years old and older have done little or no preparing for the challenging and expensive reality of aging. I think most people seem to have the mentality, "I'll cross that bridge when I come to it." Kids, if you're at least 40 years old, the bridge is here.

The oddest job interview questions

You know it is not going to go well when the person you're interviewing starts off by asking, "How much work can I miss before I get fired?" You ever have one of those? Yet that's probably not the worst I've heard.

Sequestration equals starvation

By now you've heard plenty about Medicare sequestration cuts. But you might not realize that some projects not only survived cuts, but they are getting money for projects while more important ones are slashed.

Granny caught in the cross-fire again

Once again the war on drugs catches frail elder patients in the crosshairs. Basically a "drive by" that shouldn't happen.

Kentucky lawsuit clarity: Better than bourbon

Kentucky may well be remembered for something better than its bourbon and horse races. In early February, the Kentucky Senate passed a bill where the claimants have to go before a review panel prior to filing suit against a nursing home.

Just ask Petraeus

Well, it wasn't easy to get there, but we have a new CIA director sworn in. With John Brennan taking over the spy agency, now's a good time to think back to what happened to his predecessor, General David Petraeus.

Facebook 'relaxing' ... for whom??

You may have read that spending time on Facebook has been shown to reduce stress levels but now new research suggests that learning to use Facebook may have the benefit of sharpening of mental abilities on adults over 65. OK, I'm just going to ask: Has anyone out there tried to teach a parent how to use Facebook?

The Unknown Profession: Geriatrician

OK, so I just figured out why geriatricians are the some of lowest paid physicians in the profession. It's because no one knows who the heck they are! We have proof.

We need a meaningful flow of information

"To reduce avoidable hospitalizations, you must have a meaningful flow of information." These are extremely wise words we need to really think about.

Medication reconciliation — How would Dr. Seuss do it?

Have you ever read Dr. Seuss's "Pill Drill" from "You're Only Old Once"? Wow, it's obvious he must have experienced our fragmented health system, where older adults see multiple specialists who never speak with each other and overwhelm a patient with medications they can't keep up with.

Unicorns, leprechauns, CBO Scoring and other mythical things

I recently attended the National Transition of Care Coalition Summit in Washington. It was an eye-opener.

When tragedy moves us

I don't believe there is one person who can hear about the tragedy at Sandy Hook and not be moved. I think many people are moved to a "call for action" in some way.

When 'Mary Jane' is helpful — but it's not the name of your nurse

A recent randomized trial showed that marijuana extract pills may help some patients with multiple sclerosis. Apparently, body pain, spasms, and other outcomes responded positively to the cannabis pills. However, there were associated side effects.

Wisdom from a prune

I love being a nurse and I can't think of being anything else. Do you remember a time when there was a turning point, that is, there was something that actually framed or shaped WHO you would become in your career?

Where in the !@#$% are their inspection processes?

What if compounding pharmacies were given even a quarter of the scrutiny of long-term care inspections? If that were done, I don't believe there would be a fungus among us!

If only these nursing books would be written

This past summer, Medscape had an article titled "The Top 15 books for Nurses." They were "heavy" reads and not the self-help books I thought would have been on their summer "must-have" list. I've been thinking about writing some books of my own and thought I would share what my "Top 10" list would look like.