Category Archives: Nursing Talk

MY DOG ATE MY HOMEWORK

Nursing Talk

Dear Cassandra,

Why is American Home Health so hung up on little things like clinical notes? Almost every week someone from the office contacts me about my clinical notes. I go to work and take care of my client. Sometimes I don’t have time to write the nursing notes. Sometimes the supervisor says she can’t read them. Once I spilled coffee on the clinical notes. Once the client’s dog ate them. What am I supposed to do?

Perplexed in Palos Hills

Dear Perplexed:

What are you supposed to do? What kind of question is that? You know that you are supposed to write clear, legible nursing notes every two hours. You know the times and dates on the nursing notes have to match the times and dates you Clock In/Clock Out. You know that the nurse working the last shift of the week is to mail the nursing notes to the office. You know one week’s worth of notes is to remain in the home for reference.

Frankly, I’m surprised you haven’t been fired by now. Your excuses sound like the excuses of a high school student. The dog ate the nursing notes. Please! Every teacher has heard that excuse. So you spilled coffee on the notes. Well, rewrite them. So you have poor handwriting. Well, print.

Maybe you think good handwriting is not important. A man recently tried to rob a bank. His handwriting was so poor that the teller could not read the note. She asked him to write the note over again. Instead, he fled. The teller, of course, had activated the silent alarm. The robber was arrested by police waiting outside the bank.

Why is it critical to send the notes to the office in a timely manner? In some cases, American Home Health cannot bill for services without a copy of the clinical notes to accompany the invoice. In addition, in the event of an audit by the Department of Specialized Care for Children (DSCC) or the Illinois Department of Public Health (IDPH), the auditors review the clinical notes to determine the quality of care. The auditors also compare the times recorded on the notes to time billed. Discrepancies can mean paybacks to the funding body. If nursing care is not documented, it is as if it did not happen. That brings questions of possible fraud. Do you want to be accused of fraud? If, God forbid, a child should die under unusual circumstances, the nursing notes would be reviewed by the authorities.

Always proofread your clinical notes. If you work for multiple clients, check to be sure you wrote the correct client’s name on the clinical notes. Did you sign and date the notes? Did you sign the notes using the name which appears on your license even if you have a different legal name?

Do your clinical notes contain medical bloopers? Below are actual statements found in clinical notes of other medical providers:

“Patient was unresponsive and in no distress.”

“Patient is non-verbal, non-communicative, and offers no complaints.”

“Patient was apprehended and guarded.”

Do your notes contain a malapropism? That is an unintentionally humorous misuse or distortion of a word or phrase especially the use of a word sounding somewhat like the one intended. Did you write, “We had to use the fire distinguisher.” Did you say, “The client had an expensive pendulum around his neck, and it got caught in the Hoyer lift.”

What else can you do to correct the situation? Get a Palmer method handwriting manual and start practicing to improve your handwriting. Talk with your supervisor about time management skills. Keep liquids away from the clinical notes. Keep the notes in a safe place so dogs and children can’t get them. If you are responsible for sending in the notes, be sure you send the whole weeks worth of notes and that no pages are missing. Don’t wait until the end of your shift to document the events of the entire shift. Above all, change your attitude about the importance of clinical notes. Your job depends on it.

—Cassandra

Note: First published on American Home Health's news, January 2012.

1 RINGY DINGY, 2 RINGY DINGY – Nursing Talk

Nursing Talk
Dear Cassandra,

Several times a week I call the office, or I receive a call from the office. Sometimes the scheduler is offering a case to me or confirming or canceling a shift. Sometimes I need to speak with the supervisor about a clinical issue. Sometimes I have an HR or payroll question. What can I do to make these calls more efficient?

Needs to Talk in Pingree Grove

Dear Needs to Talk,

If you watched Rowan and Martin’s Laugh In on NBC during the 1970’s, you will remember Lily Thomlin’s sketch of Ernestine, the switchboard operator. Ernestine was a nosy, condescending telephone operator who generally treated customers with little sympathy. She wore her hair in a 1940’s hairstyle with a hair net, and she often had on a white blouse. Her most memorable words were “1 Ringy Dingy, 2 Ringy Dingy. Is this the party to whom I am speaking?” (duh)

At American Home Health, those who answer the phones try to provide good customer service. Sometimes this is difficult. Our toll free number, which is (800) 872- 4427, is just one digit different from the phone number of J.R. Cigars in Burlington, North Carolina. We receive many calls from customers wanting to order cigars. Most people apologize when they realize they have dialed the wrong number. Some do not. Recently a woman with a smoker’s voice called. When the staff member answered the phone in the usual way, the woman paused. Then she said, “What the hell!” A few seconds later she called again. Once again she paused. Once again she said, “What the hell!”

What can you do to make your calls more efficient? First, always listen to the message on your answering machine before calling the office. Don’t call and say, “Someone tried to call me.” There are almost twenty people in the main office. Was it a scheduler, a supervisor, payroll, HR? What was the person’s name? What message did the caller leave for you?

Second, identify yourself by your full name when you call the office. Don’t say, “This is Mary.” Mary who? American Home Health has two hundred and thirty employees. Sometimes we don’t recognize your voice. Sometimes the caller ID simply says, “Wireless Call.” Sometimes the connection is bad, and we cannot hear the caller clearly.

Third, don’t wait until the end of the day to call the office. The office is open from 8:00 A.M. until 4:30 P.M. Monday through Friday. The phones get especially busy in late afternoon. If you need to rearrange your schedule or cancel your shift, call early in the day. Give the schedulers time to make adjustments or find a substitute.

Fourth, leave a message if the person you are calling is not available. Sometimes the calls get backed up, or the staff member has stepped away from his desk. Sometimes the person is in a meeting or is out of the office. If you leave a message, we will be sure that the individual gets your message.

Fifth, be sure that you return your monthly availability form by mail each month by the deadline. Do not expect the scheduler to take your availability over the phone.

Above all, be courteous and professional. Do not swear at the schedulers or tell them that you hate them. Remember that their job is to offer cases to you to provide coverage for the clients. They are trying to match nurses to cases within twenty miles from the nurse’s home. They must also consider the shift you want to work, what days you want to work, how much you want to work, and your skills with g-tube, trach, and vent.

Finally, upgrade your skills. The State of Illinois Department of Specialized Care for Children has fewer dollars available. That means the State will approve fewer hours of care and focus on the care for trach and vent dependent children. If you are not vent proficient, get trained. The schedulers will then be able to offer more cases to you.

—Cassandra

Note: First published on American Home Health's news, December 2011.

AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE – Nursing Talk

Nursing Talk

Dear Cassandra,

My car was low on gas, and I didn’t have time to go to the gas station on my way to work. I took my purse with the $40.00 of cash with me into the client’s home. At the end of my shift, I discovered that the cash was missing. How can I prevent this from happening again?

—Devastated in Des Plaines

 

Dear Devastated,

I’m sorry your gas money was stolen. It’s not just the financial loss. It’s the violation of trust and the intrusion into your personal space.

Once I heard a police officer speak to a group of women about ways to avoid being a victim of theft. He stated that women have a relationship with their purses that goes far beyond purses as fashion accessories or mule packs. He described how some practices make purses easy targets.

Have you ever gone into a shoe store or a shoe department and put your purse on the chair while you got up to look at the shoes on display? Your purse is marking your territory, saving that chair for you. It is also an easy target for a thief who can steal your wallet while you are admiring the shoes.

How many times have you seen a woman put her open purse into the basket of the shopping cart at the grocery store? Then she walks halfway down the aisle to pick up a jar of brown mustard. Even if she sees the thief take the wallet or purse, is she going to be able to run fast enough to catch the thief?

Have you ever hung your purse on the hook on the back of the door in the toilet stall in a public restroom? It is no problem for a thief to reach over the door and grab the purse. How quickly could you react when you are otherwise indisposed?

Taking your purse into a client’s home is asking for trouble. You are there to care for the client, not to guard your purse or money. Do not carry your purse into the home. Instead, put your money into your pocket or other concealed place. If you must carry a purse, do not leave it in the client’s living room where neighbors, delivery men, family, or children have easy access to it.

—Cassandra

Note: First published on American Home Health's news, October 2011.

THE GOOD LORD WILLING AND THE CREEK DON’T RISE

Nursing Talk

Dear Cassandra,

Sometimes I don’t feel like going to work. Maybe the Cubs and White Sox are playing. Maybe I stayed up late watching a movie, and I’m tired. Maybe I just don’t want to go to work. Why should I?

—Wants to Stay Home in Chicago

Dear Wants to Stay Home,

Why should you go to work? You don’t have a good excuse for not going! You are not sick. You are not in the hospital. You are not dead. You just don’t feel like going to work.

Say you lived in French Lick, Indiana. French Lick is a small town in the heart of Hoosier National Forest. In the early 1900’s, it was a destination for the wealthy because of the “curative” powers of the mineral spring waters. Two elegant hotels were built to accommodate the visitors. The West Baden Springs Resort, opened in 1902, was proclaimed as the eighth wonder of the world. The French Lick Springs Hotel was a Gilded Age beauty with mosaic floors, faux marble columns, and exquisite paintings on the lobby ceiling.

West Baden Springs Hotel operated until 1932. The stock market crash of 1929 and the shifting patterns of vacationers forced the hotel to close. In 1934, it was sold to a Jesuit order for a dollar and served as a seminary for thirty years. After that, it was sold several times. Over time, it became a ward of the bankruptcy court, and neglect took its toll. In 1992, the building was listed on the National Trust for Historic Preservation’s 11 Most Endangered Historic Places.

The struggling French Lick Springs Hotel had continued to operate since the turn of the century. However, it needed restoration. The elaborate plasterwork on the lobby walls had been covered by blue and white paint. Eight hundred rosette lights had been painted over. The mosaic floor in the lobby needed repair. The rooms needed updating. The Historic Landmarks Foundation of Indiana stepped in and bought the West Baden Springs Hotel. Bill and Gayle Cook, who made their fortune manufacturing medical devices, invested $382 million in the restoration of the hotels, the building of golf courses, and new spas. The Indiana State Legislature granted an additional casino license, and a casino was attached to the French Lick Springs Hotel. Today French Lick is again a tourist destination.

Now let’s get to the point. French Lick sits at the bottom of huge hills covered with trees. If there is a six inch rain, water rushes down the hills and covers the bridges leading into town. Parking lots are flooded. Businesses like Big Red Liquors, CVS, and Subway survive because the buildings have been built three feet above parking lot level. Customers can’t get into the businesses, but the merchandise stays dry.

If you lived in French Lick and you could not get to work because the streets were flooded and the bridges were covered with water, you would have a good excuse. Alas! You do not live in French Lick.

Besides, you gave your word to go to work that day. Someone is counting on you. So, buck up. Pull yourself out of bed. Put on your clothes, and get out there! You are lucky to have a job. Millions of people would love to be in your shoes.

—Cassandra

Note: First published on American Home Health's news, September 2011.

THE RIDDLER RETURNS

Nursing Talk

Dear Cassandra,

What do “Me at the Zoo,” “Guitar,” “The Bus Uncle,” and “Charlie Bit My Finger” have in common? How does this apply to nursing?

—The Riddler in Romeoville

Dear Riddler,

Welcome, Riddler. We remember how you were always presenting riddles or questions to the Caped Crusader in the Batman series. You asked, “How do you divide seventeen apples among sixteen people?” The answer, “Make applesauce.” You asked, ”What goes up white and comes down yellow and white?” The answer, “An egg.” You asked, “Which president wears the largest hat?” The answer, “The one with the biggest head.”

Apparently you are a fan of YouTube. All of these titles are titles of videos which have appeared on YouTube, a video sharing website created in February of 2005 by Chad Hurley, Steve Chen, and Jawed Karim. Hurley had studied design at Indiana University of Pennsylvania. Chen and Karim studied computer science together at the University of Illinois at Urbana-Champaign. In November of 2006, YouTube, LLC, was bought by Google, Inc. for $1.65 billion and now operates as a subsidiary of Google.

“Me at the Zoo,” the first YouTube video, shows founder Jawed Karim at the San Diego Zoo. The video was uploaded on April 23, 2005, and can still be viewed on the site. It is 18 seconds long and has been seen by 5 million viewers (Update: over 30 million now).

“Guitar” features a performance of Pachelbel’s Canon on an electric guitar. The video received millions of views and extensive media attention. The guitarist was identified as a twenty-three year old from South Korea who had recorded the track in his bedroom. It is5 ½ minutes long and has been viewed by 90 million.

“The Bus Uncle,” a video from 2006, was widely discussed in the mainstream media. It shows a heated conversation between a youth and an older man on a bus in Hong Kong. It is 6 minutes long and has been viewed by 1 million.

“Charlie Bit My Finger,” which was uploaded on May 22, 2007, has been viewed over 348 million times (Update: almost a billion times now). In the video, Charlie, a one year old, is shown biting the finger of Harry, his three year old brother. The video is 56 seconds long.

What applications does YouTube have to nursing? American Home Health currently has the following training videos available on YouTube: “Home Health Skills,” “Gastrostomy Tube Training,” “Tracheostomy Training,” “Ventilator Training,” and “Benefits Enrollment 2016.” To see the videos, go to https://www.youtube.com/user/AmerHomeHealth.

Now, here’s a question for American Home Health employees, “What topics would you like to see presented on our YouTube site?” Other training videos? Activities which foster the development of your client? A history of American Home Health? Children’s songs and games? A series of virtual field trips to places such as the Field Museum, the Shedd Aquarium, and Brookfield Zoo? A feature on a single animal such as the peacock?

American Home Heath invites your suggestions. Be creative. Brainstorm with us. Remember, there are no right or wrong answers. What would help you as a nurse? E-mail your suggestions to edward.lara@ ahhc-1.com. Your idea may go viral someday.

—Cassandra

Note: First published on American Home Health's news, August 2011.

YOU CAN’T MAKE A SILK PURSE OUT OF A SOW’S EAR – Nursing Talk

Nursing Talk

Dear Cassandra,

A business magazine recently had an article about “soft skills.” The article listed the following ten qualities that make someone a good employee: (1) having a strong work ethic, (2) a positive attitude, (3) good communication skills, (4) time management abilities, (5) problem solving skills, (6) acting as a team player, (7) self confidence, (8) the ability to accept and learn from criticism, (9) flexibility and adaptability, and (10) working well under pressure. The point was that many individuals have the license or degree, but the “soft skills” are critical to success. How does this apply to nursing?

—Thinking About It in Evanston

Dear Thinking About It,

Say you are sitting at a beauty shop. The work stations are equipped with pink and black blow dryers, electric shears, scissors of every size and type, and combs in jars of disinfectant. Orange, yellow, blue, and green plastic rollers of graduated sizes fill the portable trays. Bottles of shampoo, conditioner, styling gel, and hairspray line the shelves near the appointment desk.

The beauticians are talented individuals. Each is up to date on the latest fashion trends in color, perm, and style. They create a warm, friendly, welcoming atmosphere at the shop.

Most of the customers are regulars, men and women with standing appointments. A few customers are walk-ins. Tonight an unusual customer comes in.

Although she is a walk-in, she demands to be taken next. She uses foul language. She makes vulgar and obscene comments. Her hair is long and matted. Her clothes are dirty, and she smells bad. When she is seated in the chair, she pulls out a picture of a beautiful woman with an attractive hairstyle. She wants to be like that person. You can anticipate the outcome of this situation. No matter how talented the beautician is, she cannot transform this flawed individual into a beautiful magazine model and a good customer. She cannot make a silk purse out of a sow’s ear.

Although some nurses possess the license and the technical skills, they lack the “soft skills” essential to success at work. They are confrontational, repeatedly call off at the last minute, repeatedly “run late” for work, sleep on the job, neglect the client, and use foul and abusive language to parents and supervisors. The families of the clients soon request that these nurses not return.

Some nurses are a perfect silk purse, while some need to be reminded how their “soft skills” directly impact our clients and families. Thus in turn directly impact their career with AHHC.

—Cassandra

Note: First published on American Home Health's news, June 2011.

NECESSITY IS THE MOTHER OF INVENTION

Nursing Talk

Dear Cassandra:

Sometimes I think about the awesome duty of being responsible for the life of my client. So many things can go wrong. Private duty nurses face ventilators which malfunction, gang members in the neighborhood, the danger of carbon monoxide build-up in the home, gas leaks, rotting floors, runaway wheelchairs, school bus accidents, and the danger of fire or flame near oxygen. How can I be sure I can keep my client safe?

Worried in Waukegan

 

Dear Worried,

First, let me say that your fears are perfectly normal. What parent responsible for a baby has not gone in to look at the child just to be sure that he is breathing? In fact, studies have shown that the most important factor in the survival of a child to age three is the loving care of a parent/adult.

Although your client is not your child, you feel the same responsibility to care for the child and keep him safe. Your job is complicated by the fact that you take care of a medically fragile child.

Human beings have an amazing ability to react to emergency when survival is at stake. Exhibiting superhuman physical strength, men are able to lift cars off of accident victims pinned underneath. Others work for days to rescue a child who has fallen down a well. Firefighters dash into a burning building to rescue the inhabitants.

Sometimes having a clever idea is the key to survival. My favorite example of an unusual survival skill is the true story of an attorney who went hunting with his buddies in the swamps of the Deep South. Somehow, he and his dog got separated from the rest of the group. Trying to find the way out, the hunter waded for hours through the murky water filled with snakes, turtles, and alligators. When he was exhausted, he would sit on a fallen log. His dog would swim over to the log and climb out of the water to rest, too. Night came. Still no rescue.

The next morning the hunter heard the sound of a small plane flying over the area, apparently searching for them. The plane even passed overhead, but, since the hunter was dressed in camouflage, the rescuers did not see him. Then he had an idea! He ripped off his white Jockey briefs and tied the underwear to the barrel of his gun. When the plane flew over again, the hunter waved the gun with the white cloth tied to the barrel, and the rescuers saw it. Saved by “tighty whities!”

The honest truth is that you cannot be sure that you can keep your client safe. You can only do your best. Review safety procedures. Try to anticipate dangers. Try to prevent accidents. Have a plan of action in place in case of emergency. Should those fail, keep calm, use your wits, and remember the story of the hunter saved by his underwear.

Cassandra

Note: First published on American Home Health's news, May 2011.