The one in which I talk what little politics I know.

I get an e-mail every day from the ANA with the most important news articles regarding health care. I like it, because it keeps me updated on things going on without me having to search around for articles. I found an article that was very interesting to me, as it pretty much sums up the job I want to have some day. (not today, mind you. some day.)WSJ article
http://online.wsj.com/article/SB124873545269485081.html

I want to do long term outpatient care. Not in a nursing home setting, but it a HOME setting. I get so many repeat patients, frequent fliers as we call them. People with CHF, COPD, renal problems. I truly believe that if we could do more with them as outpatients we could prevent this. If I could call Mr. W once a weeks and talk to him about his meds and his weight and what his blood pressure was doing, if we could visit and I could check for swelling, if I could do this than he wouldn't know my name because I have taken care of him every couple of months for the last year.

And now I get political. IT ISN'T PAID FOR! Home health won't cover it, because most of our patients don't fall under the guidelines for qualifying. Apparently Medicare is now threatening to cut funding for repeat customers, and yet they aren't setting up programs to help pay to keep people out. The Massachusetts hospital that has a program like this had this to say:
"readmission rates for these patients (in the outpatient program) have fallen. But it isn't reimbursed for much of its efforts. "You do it because it's the right thing to do," says Diane Kelly, the hospital's chief operating officer. "But doing the right thing is getting expensive."
We could control this by helping with blood pressure, weight gain, swelling, etc. We can adjust outpatient meds to keep people OUTPATIENT.

"Attention to these issues can reduce readmission for heart failure by as much as 30% to 40%, according to pilot projects studied by Yale cardiologist Harlan Krumholz. But the services in such projects often don't qualify for reimbursement by private and public health plans. In a 2005 study, Dr. Krumholz and his colleagues reported that 13 of 15 successful projects to reduce readmissions were canceled after special funding for them ran out.
"These hospitals knew they had something that worked," Dr. Krumholz said. "But they couldn't come up with a business model that could afford it."

So here is what I am saying. If medicare and private insurance wants to keep people out of the hospital, they need to stop threatening us with taking away our funding, and instead start offering to fund some new programs. SERIOUSLY, HOW HARD IS THAT TO UNDERSTAND???

I really like this article. Things like this work. It is proven. There are stats. There just aren't enough programs like it. No offense, I understand that you think health care should be cheap, and that we add things just for the sake of it, but if hospitals are businesses and trying to make money we can't expect them to run programs for free. Here is something else. When I first got hired(or maybe when I was in school..) someone told me that patients will only remember like 10% of the education we do in hospitals. That is why we send so much printed paperwork home with people, so they can read it later. So don't get after us for not educating enough, not making sure people have enough and know enough to come back. WE EDUCATE LIKE CRAZY!!! Every time I give meds, talk about procedures, EVERYTHING i do with patients I am trying to educate, trying to do everything I could to keep them from coming back. Honestly, though, trying to teach while someone is sick isn't the most effective. Outpatient is.

Does any of this make sense? I am trying to put my thoughts into words... I might have to revise.


Winslow, Rob and Jacob Goldstein. Cutting repeat hospital trips--simple idea, hard to pull off. WSJ http://online.wsj.com/article/SB124873545269485081.html

My hospital rocks.

I read two e-mails posted to various bulletin boards last night.

The first: CONGRATULATIONS NURSES!!! S*** (my hospital) has been voted as having the best nursing staff giving the best nursing care in J************** county (my county). It was an exciting e-mail to read. Most of the time we are being told how we need to do better on stuff, so it was exciting to see how people already think we are doing a good job.

The Second: a note in a much less obvious place telling us how most of us set up facebook/twitter/youtube/blogs as a personal forum for family and friends, but that we signed a code of conduct and we are reps of our hospital and how they except us to only share positive things. Or something like that.

So for the record, I like my hospital. I would let people I love go there. I would handpick their doctors. and nurses. but I would let them go. These are the positive S*** thoughts I am sending into the universe.

I had my midyear review today. Probably shouldn't have agreed to do it this morning, due to being seriously pe-od at a person in a department I shall not name in honor of being nice to my hospital, for this post anyway (but, RaDonna, was not the ED for once. Just to let you know). We talked about things I am doing, and I came away feeling fairly confident that with a little effort I can get in the exellence category towards raises next year. If, you know, they give us raises. She is going to get me info on becoming a PCU certified nurse, which I would totally love. I also found out that PCU is apparently considered critical care. It seems to be somewhat controversial, our CNO thinks it is, and my manager (who I love, by the way) thinks we are more advanced med-surg than easy CC. Who knows.

and my boss thinks I should take some leadership classes. Who knows why, but I think i will, since she suggested it. Maybe something cool will come of it...

end of post.

And so begins the second chapter.

When I graduated last May, I figured that I would be doing this job, in some form or another, for 40 years. Be a floor nurse for a while, get an advanced degree and do that for a while, get a job teaching and do that for a while.

The first year was hard. Oh so hard. Around April, 9 months in, I woke up one morning. (and by morning I mean afternoon. I don't do mornings.), and realized that it was starting to make sense. That I was comfortable in my skills as a nurse. That I was calling Doctors without first asking advice. That I can handle chest pain without calling the charge nurse. That I can be insanely busy with really sick patients and not panic. That I can prioritize.

Day number one of year number 2/40 started with a phone call at 7pm. "Corrie, It's Nancy from staffing. We were concerned that you were not here yet." Apparently I have lost the ability to remember my schedule, and I thought I was supposed to work Thursday. Not Wednesday. I made it out my door in 6 minutes. I was at the hospital 15 minutes after the phone call. I started getting report at the same time I usually get done getting report. Everyone was teasing me. It is a testament to how excited I was about Colorado that all the nurses, day and night, all were teasing me that I still had Vacation on the mind and asking me how Colorado is.

It was a good week. A good way to start year number two. I talked to RaDonna last week about how her job is going, and all the feelings of the newbie nurse. I remember those days, but am starting to feel like I am past them. Not entirely. There is so much more to learn it is a little overwhelming. But still. I have made it through the first year.

It is a good feeling.

In other news. This day last week I was floating down the San Juan river, at a temp of 54 degrees, give or take, freezing my toes off. It was fun. We have no pics to share, mainly because there is no logical way to take pictures in a river without getting the camera wet. Last night I went camping, and it was pleasant. I mean, as pleasant as sleeping in a tent can be. until like 530 this morning, when the worst thunderstorm of the summer happened. With me in a tent by myself. I pulled on clothes on top of my other clothes, packed my bags, and hi-tailed it over to my parents tent.

I am now done pretending to like it outdoors, and plan on spending the rest of the summer sitting on my couch reading.

an unfourtunate event

Have you ever had one of those moments where time stands still and in that moment you ask yourself "Did I really just do that?". The room closes in around and you realize in shock that yes, yes you did do that terrible thing you dread. You would rather be swallowed up into the floor than face the consequences of your actions.

Obviously I had one of those moments today.

It occurred at 10:50 am and in 3 seconds I was aware of the fact that I had stuck myself with a dirty needle. I was sick with shame and fear. I calmly threw away the offending sharp and ripped my gloves off. Blood pooled on the tip of my thumb as I walked over to the sink and scrubbed my thumb with soap and hot water. It's amazing how what little they taught me about needle sticks in nursing school, somehow floated to the forefront of my mind. I continued to wash my thumb for several minutes and squeezed blood out of the puncture wound. I slapped a 2x2 on it and sought out my charge nurse.

She calmly heard me out then proceeded to check me into room 17, take my vitals and helped me start the huge file of paperwork. I had a few minutes before the ED doc was going to come in and evaluate me so I went outside to get some air and call my mom. That's when the tears came. I wasn't exactly scared for myself (the patient was very low risk as far as possibly having HIV and Hep B or C), I was mostly furiously angry at myself. I could only imagine what everyone was thinking. "Newbie nurse should have been more careful". I felt so inadequate and stupid. My mom told me it would be ok and it was a good learning experience for me. This is true but I would have rather have learned this lesson some other way.

For the rest of my nursing career, I know I am going to be so cautious with sharps of any sort, especially 23 gauge butterfly straight stick needles. Even now I cringe thinking about what happened! How could I have done this! I know better! ARRRRRRGGGGGHHHHH!

My preceptor found me sniffling in the parking lot and assured me that she had been stuck several times with dirty needs and was even put on the anti-viral medications. So many healthcare workers have stuck themselves but it made them all better at their jobs. She said the risk for getting something was slim to none and to not worry, it would all end up ok. So I pulled myself up by my bootstraps and went back inside and down to the lab to have my baseline labs drawn and to get a urine drug screen (workman's comp you see). The patient consented to having his blood drawn for HIV testing, amoung other tests. The results to the rapid HIV test came back negative much to my relief.

I learned a valuable lesson today, one that I won't soon forget.

Colorado: 3 days of awesomeness. plus two days in the car.

We had grand plans to post while in Colorado. However, we were too busy having fun, or recovering from having fun, to do so.

It was fun. We had no schedule, no set plans, no place we had to be at any certain time. It was my mom, dad, cousin Jessy, RaDonna and myself, and we just relaxed. And did more exercise than either of us do in a month.



We walked around town with the craft fair. I got sunburned all over my shoulders and back. It hurt the rest of the week. We went to a great mexican restaurant. We walked around Echo Lake,



and up Treasure Falls.


For the record, mountain runoff waterfalls are cold. As in my toes froze in less than 2 seconds and it hurt like mad cold. BRRRR.

We talked. We hung out. We enjoyed life. We saw beautiful views that girls from Kansas and Florida don't often see.

I don't have to go back for 8 days.

She is on a plane flying to me as we speak. Or type.

Life is good.