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.

Why I love TV's Nurse Jackie

So we all know that nurse have a love-hate relationship with "medical shows" on TV. The good news is there is at least one thing to love.

Nurse overload equals mistakes

Did you hear the one about the seasoned detective who finds a body in a field? Surrounded by young detectives, he immediately announces, "She was a nurse and worked in long term care!" Stunned, the newbie detectives ask, "How on earth can you tell that?" "Easy," he says.

You go, girls! A year of nakedness

If you think you've seen it all, you haven't. That's because they didn't bare all, just almost all. This is awesome. A dozen women in their seventies and eighties decided to raise money for their retirement community's benevolent fund by becoming "calendar girls."

Nursing and stress

Nurses continue to experience stress at higher rates than most other groups, according to the American Holistic Nurses Association. OK, so we know nurses get stressed — just walk into any nursing home or hospital and look around —but let's break this down.

Breaches of basic infection control practices — why?

Basic infection prevention and control isn't rocket science. It is essentially following some general guidelines. Some of them pretty simplistic. Not too hard right? You would think, but ...

When physician observations cause pain

A panel of doctors was asked for its opinions about a proposal for a new wing at the nearby referring hospital. It was tough to get a straight answer.

Mandatory vaccinations vs. voluntary — not for wimps!

Let's talk about that controversial topic: mandatory healthcare worker influenza vaccination. I can hear the arguments for both sides already. But I say the case is clear.

Once again the war on drugs forgets LTC

A proposed reclassification of painkillers is one more example of how the long-term care setting gets left out of policy discussions, and frail elders will pay the price.

Sweet treatment you'll crave: Chocolate helps the heart

Oh, happy day! Now here is a study that I think pretty much everyone can get behind. Researchers found that dark chocolate (at least 60% cocoa) may be an inexpensive and effective way to help prevent cardiovascular events and reduce your risk for heart disease.

Remembering Momma

Some of us are blessed to still have our moms; some of us are blessed with memories.

You know you're a nurse when ...

OK, I can't help myself. I'm in an incredibly silly mood as I sit to write my blog today. And I was thinking about how we as nurses see the world differently from "normal" folks. We are a sister- and brotherhood of odd humorists. Because if we can't laugh at it, we can't be a nurse!

Paying so docs communicate better

So I was reading this article in a publication related to improving patient-centered care. It stressed that essential to delivering that type of care would be physician/patient-centered communication skills.

Specializing in diverting primary care

A recent article in "Research Activities Report," an AHRQ publication, was titled "Primary Care Coordination is More Difficult for Patients Who See Many Specialists." The study "suggested" that a patient's high use of specialists might strain the primary care practitioner's ability to coordinate care. Really?

The nightstand is the window to the soul

I think you can tell a lot about a person by what is in his or her nightstand.

Why do we do some of this 'stuff'?

We do a lot of "stuff" in nursing that makes no sense (both in acute care and long-term care — I'm not singling us out here). We do a lot of things that waste precious time and are definitely not evidence based. Let's take a look at some myth busters.

What I'm wishing for

So right around Thanksgiving I was watching a trivia game show and the question came up: "What do 23% of Americans have for Thanksgiving?" My immediate thought was, "A burning desire to discover that they were adopted."

Going back to servant leadership

I have to wonder why, when some people get in a "power" position, they kind of turn into real ... dictators. We've all seen it, everyone from the nursing assistant who gets promoted to mentor "newbies," to CEOs of large associations or corporations, to some in political positions. Maybe they feel serving their own needs outweighs others.

SGR fix?! Don't get me started!

So here's a Sustainable Growth Rate (SGR) 101 primer so you will understand why I am so upset.

When good excuses go bad

Do you ever sometimes just want to say, "I'm not buying that one" when you get some absolutely bizarre excuse from a staff member as to why she called out?

Pharmacists and doctors and nurses — oh my!

As I was thinking about packing for a recent convention — and those who know me know a lot went into wondering about how many pairs of shoes I could get into my suitcase — I started thinking about the healthcare conventions I go to. Specifically, I reflected on just how different the Q&A sessions are.

More on caffeine (or 'What nurses know already')

A new study on coffee drinking habits and results should give nurses plenty of reasons to smile. I can back up the results personally.

Evidence schmevidence

Why are Western doctors so resistant to complementary alternative medicine and supplementation? When you mention this, no matter how evidence-based, they look at you as if you just said, "Hey, let's get a naked, chanting shaman in here waving clucking chickens over your patient's head."

Hope for old broads seeking sexual satisfaction

Hey, does anyone out there remember my first blog? I mentioned sexuality in aging to get things started off? Well interestingly, a recent study by researchers at the Stein Institute for Research on Aging at the University of California showed that successful aging and positive quality of life indicators correlate with sexual satisfaction in older women.

Because We The People demand it!

Patrick Henry once said, "The Constitution is not an instrument for the government to restrain the people; it is an instrument for the people to restrain the government — lest it come to dominate our lives and interests." Wow, how timely.

The American Jobs Act and the 'Real' answer

Last Thursday, the president spoke on the American Jobs Act. I was very surprised he didn't mention that geriatric care is THE way to stimulate the economy and create jobs.


I'll bet that "regdiculous" and "disgustipating" would become a part of normal vocabulary at your workplace immediately.

Transitions of Care III — Scarier than a horror movie: Medication errors

We've been talking for a while about transitioning of our residents to and from the facility and some of the problems associated with it. But let's talk now about just one huge problem, that big elephant in the room: medication reconciliation. This stuff is scary.

Transitions of Care, Part II: So you know they're eventually gonna have to leave ... right?

OK, I'm not talking about your kids, because we all know they NEVER leave, and if they do, they keep coming back like boomerangs. I'm talking about your residents. Let's face it, one day your resident is going to have to leave the facility. Come on, don't act so surprised.

Transitions of care: Quit blaming us for the bad 'stuff'

OK, so we all know that the pressure ulcers always form in the ambulance on the way back to your facility from the hospital. It's ALL YOUR FAULT. Bad, LTC, bad!

Honor thy mother and father

My Mom's biggest fear is that she will get Alzheimer's disease and become a burden to me. If Mom would ever realize that fear, I would do everything to ensure that I honored her. I know what mom wants.

When to hope for a naked intruder

I've already written about it being a blessing and a curse to work in long-term care because we know so much about aging and what happens to our bodies as we age. And because I know what is happening, there are just some things I really don't want to see. OK, so here's my latest beef.

Try it: 'I don't know'

Let's face it: Often there isn't any solid evidence as to why a resident is on a medication. Many times, they came from the previous location on a bucket load of medications and they stay on them.

It's not a bad habit: What's your coffee IQ?

So it's 4 a.m. and I'm still up finishing a project and jonesing for a cup of my favorite brand of coffee, NuJava. Yes, I am a coffee snob, because I like my coffee like I like my men ... straight! (And hot and strong and full bodied ... and where was I going with this? Sorry, I digressed!)

Everything old is new again

So there I was, out having a blast on Cinco de Mayo, enjoying an "adult beverage" and some really great food with plans for NOT working for the rest of the evening, and I get an emergency text from my boss.

Proud ... and not apologizing

When did it become so popular to be "antipatriotic"? Does it make you "hip" nowadays?

The Aging reality show

One of the things about working in long-term care is that it's both a blessing and a curse — knowing about aging. For example, it's not a good thing when you aren't prepared for it, right? I remember clearly (it's actually indelibly imprinted on my brain for all eternity) the time I was not prepared for the changes aging brings.

Keeping it real

Let me introduce myself. My name is Jackie and I am (proudly) a long-term care nurse. The editors at McKnight's are brave enough to let me start a blog. It might at times be slightly irreverent, thought provoking and challenging, and it might cause you to become introspective. Throughout, I promise you one thing: I'll keep it real.

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