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  #11  
Old 02-22-2008, 03:32 PM
Marachne
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First I want to thank Julie for saying much more gracefully what at least a few of us have also thought/felt. Angela, you do have a great wealth of experience that is clearly leavened with intelligence and insight. I too have a large investment in LTC, and trying to figure what we can do to help a clearly broken system. That's part of why I'm involved with the HCGNE Nursing Home Collaborative.

But when you started this thread by quoting the NT, and then I scanned down and saw all the G_d talk, well, I stopped reading. I think Julie phrased it beautifully in trying to make the concerns universal, but I guess I want to add a personal perspective:

I'm Jewish and a child of the holocaust -- not in that any one from my own family was lost (more like they were killed in Russian pogoms that were incited by "blood libel" -- killing Jews because we supposedly use Christian baby blood in making Mazo), I was raised in an atmosphere that emphasized celebrating/holding onto my Jewish identity. When people start talking about their beliefs in such a way that make it feel like they are stating universals, I get uncomfortable and yes, feel a bit threatened as I feel it is erasing the possibility of any other way of approaching one's spirituality/idendity.

Just as us 'mericans need to remember that this is an international discussion group, those of any dominant paradigm (be it white, heterosexual, in this setting female, etc.) need to remember, and leave room for other ways of perceiving and approaching the world.

Peace

Miriam
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  #12  
Old 02-23-2008, 10:07 AM
gracenotes1
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Oh no--I am not offended!! I have been a urse for 20 years it takes a great deal to offend me. hahaha
Maybe I can write some shorter type devotionals. I have so much going on right now with my book and everything involved in promoting it. Plus, I have signed up with www.discovernursing.com to help recruit new nurses. I am a busy busy retired person!!!
I enjoy reading and posting here.

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  #13  
Old 02-23-2008, 10:10 AM
gracenotes1
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I am so sorry Miriam. Please accept my apologies for being so thoughtless and not considering the feelings of others. Please forgive me.
Angela
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  #14  
Old 02-23-2008, 04:21 PM
Marachne
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Angela, you are more than forgiven. I know how it can be that something this is so central and important to one's life can make one blind to other's perspective. I am glad you're part of this community and here to share your knowledge.
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  #15  
Old 02-27-2008, 07:52 AM
gracenotes1
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Red face

I have been trying to think of some tips that I could give to Lonng Term Care Administrative Nurses: Especailly for DONS

I came up with a few that helped me during my "tour of duty"

I'll just post one at a time--see if yall have any comments or tips that you have found helpful.

(1)*Attend care plan meetings at random* (sneak up on them)

It helps to show support and involvement. If you are interested in the MDS Care Plan process then your staff will be interested as well. Spend a day with the care plan team and do so frequently. And never let them know when you might be coming. Give your input but also be there to learn.

For example: We had a little problem with our care plan team getting all cozy in an office and just MDSing and care planning their little hearts out, amongst other things.

These MDS assessments could not possibly have been accurate because you cannot do an assessment without assessing the patient. So first problem solved, MDS coordinators had to actually do assessments. Now I know that might sound crazy because what kind of nurse would complete an assessment and not assess the patient? The answer is a lazy one and an overwhelmed by paperwork one.

How could a licensed nurse sign her name to an MDS that she completed without ever even seeing the patient? Believe me, it happens and as the DON or nurse administrator it is your job to make sure the MDS reflects an accurate picture of the patient at the time of care planning.

What good is an MDS and a care plan if it is not for the care of the patient? Yes, I must admit that the MDS was created by the government and it does not make sense in some places but the overall concept does make sense and it is what we all learned in nursing school. It is an assessment, an ongoing assessment.

It has to include the actual patient. Without an assessment how can you set goals and interventions?

I was a sneaking little DON. My nurses always said that I could be standing right behind them before they ever saw me coming. I learned alot by doing that. hhahahah And it tickled me!!!

So--what do yall think about that?

Last edited by gracenotes1; 02-27-2008 at 07:54 AM. Reason: thought of something else
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  #16  
Old 03-02-2008, 10:10 AM
gracenotes1
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Calling all nurses!!!
Consider yourself HUGGED today. You deserve a great big bear hug!!
For every patient you have cared for this week. For every Doctor you have dealt with professionally without hitting him.
For every family you have encouraged and helped
Consider yourself hugged!!!
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  #17  
Old 03-05-2008, 11:58 AM
gracenotes1
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One of the most effective characteristics of a great leader is the ability to listen. Many times I have heard people complaining about their boss saying that “they just don’t listen”.

Listening to other people is sometimes difficult for one reason, it takes time. Time is not something that you will have an abundance of, but there are ways to save time and listen effectively at the same time.

Because you hold the position that you do many people will want your undivided attention. You will have staff members that will want to talk to you, you will have family members, patients, your boss, other department heads, hospital social workers, and sales reps, well the list could go on and on. You will have to take the time to listen to people. Take notes and really listen.

Say for instance, one of your 11-7 LPNs is waiting on you when you arrive first thing Monday morning. Now, on the first thing Monday morning you will have many things on your plate and a thousand more things on your mind. But, you will have to take the time to listen.

So approach these ‘listening sessions’ with an open mind. Probably and more than likely it will take this LPN 5 minutes to tell you what they want you to know. Your response and your reaction will dictate how much time it cost you after that. So listen the first time, write it down and read it back and then decide what to do from there. Triage again.

As people report information to you, get out your pen and paper and with pen in hand, listen. Write down the main points.

Make sure that you convey to the employee the feeling that you have nothing else to do but to listen to her. Don’t talk; don’t try to solve her problem before she tells you what it is. Have you ever seen anyone do that? It isn’t pretty. You have to hear people out. Don’t be thinking about your response until you know you have the facts. Just listen.

Don’t sit there and think of how you are going to answer, just listen. Make sure you write down the main points. The last thing the person says will probably be the most important thing they have to say. If the repeat something be sure to write that down. People repeat themselves when they want to be sure you are listening.
Your job at that point is not to talk, it is to listen. Even if she has 22 problems to present to you, all you have to do is listen. The quicker you acknowledge their problem the quicker you can move on.

When the other person is finished telling you, maybe in 10 different ways, possibly beating around the bush, be patient. Go ahead and review with her what you heard her say. let her know that you heard her.

Whether you are able to solve the other person’s problems or not, you have done what you needed to do and you have done what she needed you to do. She needed you to listen.

What ever action you need to take will come later. But for those 5 minutes, you listened and that is all she needed you to do. Don’t look at your watch; don’t do anything else but listen. The more you act distracted and detached the worse the situation will become and she may keep you tied up for days on end. But, if you listen, really listen you will gain her respect and her loyalty. Plus you saved time and effectively solved a problem all at one time. Two birds with one stone, so to speak.

You must listen to your staff. They work those floors directly with the patients for 8-12 hours a day. They are your eyes and your ears. Feel confident when they come to talk to you. Be glad that they feel like they can talk to you. The worst thing you can do is to have an open door policy with a closed mind atmosphere.

It doesn’t matter if your door is always open, if your mind is closed and your heart is locked up, the physical door makes no difference. Actively listening takes skill and talent and you must develop this ability.

When they leave your presence make sure they leave knowing that you heard every word they said.

Making a practice out of listening will be an asset to you. There may be times that you see somebody coming and you want to run and hide. Don’t do that no matter how bad you want to. You will look silly hiding in the med room.

I had this one family member that would come in my office and stay for an hour. It got to be really a problem, but all he wanted was for me to hear him. I started out listening, just listening and trying to respond. I learned that if I wrote down his concerns without responding, then he accomplished his mission quickly and stopped coming so often. This meant he was spending more time with his mother than chewing my ear.

So learn from my mistakes, don’t try to respond. Just listen, write down the main points and you will accomplish several different things at once. You will gain their respect and loyalty, you will set family members minds at ease and the word will get around that you are a leader that can be reached.
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  #18  
Old 03-07-2008, 09:09 AM
gracenotes1
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Well ladies and gentlemen!! It is Friday. If you are off the weekend then whoohoo. enoy the rest and relaxation--especially if someone else is taking call!!!
Do something fun--whatever you like to do!!
Don't even think about Monday until Sunday night!!
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  #19  
Old 03-08-2008, 08:43 AM
gracenotes1
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My position as a Director of Nursing in a long term care facility sometimes required long hours. On this particular day in January of 2001, I was running later than usual on my commute to work. The day before, I had worked 16 hours and I almost took the day off because I was so late getting home the night before. But I really needed to attend an important meeting at 10 am.

I had sold my 1997 Mustang in order to get a bigger car with a smoother ride. I borrowed a car from my Daddy until I could get another one. So, I was driving what I lovingly referred to as, “the land barge”, a 1989 Mercury Grand Marquis, built like a tank.
As I was driving to work, a day just like any other day, I stopped at a red light at a busy intersection. I remember thinking that I should pull up to the driver beside me and tell him that his hubcap was about to fall off. The next thing I remember is hearing a loud noise and looking to the left. I saw a huge truck on its side sliding toward me at a phenomenal rate of speed. Sparks flying I knew that it was going to hit me and it did. I only had time to say, “Lord, that is going to hit me!”. I grabbed the steering wheel as tight as I could. It happened so fast.

I never lost consciousness. I do not remember feeling the actual impact. Jesus and His mighty angels got to me before the truck did. I do not recall being knocked 275 feet into a gas station parking lot. I don’t remember being airborne. I do remember something else though. I remember an incredible feeling of awesome peace and love like I have never experienced before. I had a glimpse of heaven. The hedge of protection came between me and that huge truck. My car was crumpled into a heap of metal and I was trapped inside. But inside the car were angels. I saw them and I felt them. They were there immediately, and I remember saying to them to go ahead and take me if it was time. I had no fear of going with them. I wanted to go with them. Nothing else mattered. I did not hear any audible voices but I knew somehow that I was not going to die, not yet. Somehow they told me that. Jesus was there. He did not speak but I felt His arms around me. Even after the paramedics got me into the ambulance, the angels were still with me, I knew they were there and that was all that mattered. Their presence was overwhelming.

At the hospital I could hear all the nurses and doctors talking and scrambling while they worked with me. I knew that I was critical and that I was loosing blood. I could feel myself slipping away. I knew that the angels were there just in case. By the time I was evaluated in the emergency room the pain was almost unbearable. Again, I saw the light of the angels, small tiny brilliant lights circling around above me. Even through the pain I smiled and felt comforted by their presence. I talked to them, this time asking for them to take me because the pain was so intense. The things of this earth were “strangely dim”. The next thing I remember is seeing my husband and my parents. Then I started to cry. Doctors were rushing me to surgery. A surgical nurse leaned down and called my name, “Angela, in a minute you will be asleep and you are going to be fine.” Then she started praying for me so quietly and sweetly in my ear as the anesthesia took effect.

I woke up in the ICU and recovery began. The first thing I told my mother was about the angels. I continue to improve everyday and I have come a long way in healing since that day. My life will never be the same. I strive to never forget the feeling I had that day. I almost left this world, and in the process I was given a great gift from God. He offered to me the blessed assurance of His presence and His awesome power and love. I never want to forget this small glimpse of heaven. I felt the incredible love of God present with me in “the land barge”.

Soooooooo the moral of this story is be happy you can still nurse. I miss it so badly.
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