No nurse is an island

Let's face it, healthcare is siloed enough without nurses running around with an "I'll do it all on my own" attitude. Pride is a toxic condition no nurse can afford to suffer from.

Where did all the spoons go?

As nurse leaders/managers, I believe we have to be smarter in what we decide to let go and shrug off, as we might wind up having to do those things ourselves too often.

Sorry, King Solomon, but I don't agree

No matter what your faith, pretty much everyone has heard of King Solomon, son of King David, who was given the gift of wisdom. How, therefore, can I say I think he is wrong?

Antibiotic stewardship — embrace the change

Antibiotic stewardship is a change you need to embrace. You can't just say I prefer it the old way, give everyone an antibiotic who asks for one and that will be that. But I get it. You are willing to change, but sometimes the residents and their families aren't.

We never shut down

As the government shut down over the weekend, it struck me once again: We in long-term care do not close our doors. Ever.

Look on the bright side

You know, it's really all how you look at things. We all have days that stink, but spinning the situation differently can change how we deal with apparent downers.

I heard the call bells on Christmas Day

With Christmas songs still echoing in my head, I bring you original lyrics, with special thoughts of our hard-working long-term care nursing corps in mind.

When will we ever get good press?

You know, a lot of great stuff happens in the long-term and post-acute care setting. But nooooooo, no one ever wants to talk about the good stuff. One bad apple and the mainstream press go wild and we all get the black eye.

Ode to The Road Warrior

Here's an original poem I wrote that hits close to home for so many caregivers. I call it "Ode to The Road Warrior."

Wheezes and crackles and rhonchi, oh my!

Come on, people. We work in healthcare with the oath to protect the people we CARE for. So stop that whining and do what's right.

Nursing documentation does it again

Let's face it. Nursing documentation can get you in trouble with your supervisor, make a surveyor faint, make a lawyer rich or make blog readers laugh. I'm going for the last here. What follows are actual examples I found after a quick search. Honest.

But ... we've always done it this way

Almost nothing burns my cookies more than when someone says, "I've always done it this way," despite having poor outcomes.

So worth it — you better believe it

Sometimes you have to invest your time and work for what is worth achieving. Not everything, even in this day and age of instant gratification is going to come easily. And this includes many of the new skills we are going to have to learn to evolve with the changes in healthcare.

Observation overload

OK, so any nurse reading this will probably relate, but we are so used to observing our patients/residents that we tend to "over observe" when not at work.

A solar eclipse of the heart

As Bonnie Raitt's "Total Eclipse of the Heart" was playing in my head for the days leading up to Monday's solar eclipse, the national news of hate and division that's been inundating us took on a new meaning to me.

Life is like an apple

Have you ever contemplated on an apple? Not the tech stuff but the fruit.

Magical moments

I am not sure we can create magical days for everyone in our long-term care facilities (though I have seen downright miracles for some short-term rehab patients!). But I do think we can create magical moments by adopting some of the Disney customer experience culture to create magical moments.

At home from minute one

Let's face it: While some of us may be great at welcoming new residents, most of us are checking off our regulatory boxes and inventories and documenting.

Holy lost childhood memories, Batman!

I am sure many of you heard that the first media Batman, Adam West, passed away on June 9. I feel like some of my childhood passed away with him. You see, he made an immense impact on pop culture at the time.

Happy Birthday, Donald Duck! Your care plan is ready

Donald Duck officially turned 83 years old on Friday, having been "born" in 1934. I have to wonder: If he were in a long-term care facility today, what would his person-centered care plan look like?

Multiplying your influence — what it means to mentor

Becoming a nurse manager doesn't just "happen." (It's not like, "Poof! You're a DON!") Someone took the time to mentor the nurse manager and train her to develop into the role.

What I would say to young Nurse Jackie

I started thinking: If young Nurse Jackie knew what she would have to go through to get a smile of contentment on her face, would that huge smile turn to a look of horror? Could I have let her know that everything she would go through would be what would bring about that smile of contentment she wears now?

Ode to Antibiotic Stewardship

Oh, Ab Stewardship, some fear you so. The way we did things, Is hard to let go.

Ignoring the old impulses

So, I have this song from Disney's animated film "Frozen" stuck in my head. The part of the song that goes, "Let it go, let it go ..." See, that's how I feel about urine cultures.

You can't build a faster horse

I was taking with someone about innovation. They told me about a famous quote from Henry Ford. Supposedly he said, "If I had asked people what they wanted, they would have said 'faster horses.'"

Trimming meal support for elders will cost us more, not less

I've always talked about growing old gracefully. I never thought about being scared to grow old. Until now.

A heart for learning

I was thinking about obstructions to learning while recently working on some educational initiatives. It occurred to me that one of the largest obstacles is a closed heart.

Learning by doing

OK, so here is something I totally don't understand. It has to do with how a lot of nursing staff think about new hires. (Probably Chapter 2 in my imaginary book, "Eating their young / a nurse's guide to orienting and mentoring.")

Fear of intimacy

Intimacy ... I'm not writing about where one partner is hounding the other about fear of opening up and getting close. What do they say — "It's me, not you"? What I am writing about is fear of getting close to our residents.

C'mon, give me a hug!

With so many obscure holidays out there, I notice there is no "National Appreciate a Nurse Day." Nursing Home Week and Nurses' Week do not count. I want a day to put on my tiara and not feel weird about it!

Let them eat cake!

As our long-stay residents age in place, often we see them get to a point where we begin to notice that they are reducing their intake. Often, they are prescribed less-than-desirable-tasting supplements. I saw let them eat cake!

Dreaming of a Quiet Christmas

Next year, I'm going to have a new year-end holidays theme song. Using the melody of that Bing Crosby chestnut that sold millions and millions of copies, it goes something like this (hum along with me):

Dealing with the 'S' in Communication

I know, I know, you're looking at the title and thinking I lost my mind. Where is the 'S' in word communication? Oh, but I say yes, it is there and I see it. You see, we all receive communication with certain sensitivities.

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.

Hacking goes to new and deadly limits

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).