Never Have a CVA in Another Country – the Canadian Tourist

ER called report. My next admission was a stable middle-aged male with TIA. OK, another TIA – I knew the protocol. No big deal on my M/S unit.

He was a Canadian tourist who was in town with a tour group composed of his fellow church members.

He arrived alert. But when we asked him to stand and transfer from the wheelchair to his bed, he could not bear weight on his left leg or use his left arm effectively. His speech was a little slurred as well.

The transporter read my furious expression and went into defense mode. She swore, with a vow, that he was not like that when she put him into the wheelchair just minutes prior.

I was livid! This was no TIA, and putting an evolving CVA into a regular hospital room was not OK. I told the charge nurse and called the doctor.

The charge nurse, and several other nurses, verified my claims. But still – we could get no orders for an ICU transfer – no orders to consent him for TPA – and no explanation of why!

The next day, the doctor told the patient that he had, indeed, had a stroke. He said that our hospital would work with his Canadian insurance and provide him with the best treatment options that his policy would allow.

And the doctor added that it was wise of him to have taken out a traveler’s health insurance policy to cover him on his trip. I was thinking, “Then why didn’t you do more for him yesterday?!”

With the news of his diagnosis, he was shocked and called his daughter, with help, and she said she would fly down to see him immediately. He cried – and I felt like crying too.

Soon the therapy began. He was given PT, OT, ST, and every kind of TLC we could think of for him. What a kind person! We all liked him so much!

His tour group visited him. His daughter came and brought him mementos from home. He was a well-loved mRed Maple Tree Canadaan.

Meanwhile, our hospital case managers worked with the Canadian insurance people to try to get him home as soon as it was safe for him to fly.

I could not help but wonder, since his CVA was not hemorrhagic, was the lack of aggressive treatment that first day political or insurance-related? Doctors would not answer.

Did his traveler’s insurance contain exclusions? Did our hospital really provide this patient with the best that his country allowed? Were our hands really tied?

I guess I’ll never know about his particular case. But the patient stayed with us a good two or three weeks -receiving his therapies until such time that he could return home.

What a remarkable and kind gentleman! He went home with deficits. But at least I know that the nurses, therapists, and case managers provided him with the very best that we could give, and it was a pleasure to do so.

For more information about traveler’s insurance: Prepare, Travel, Return: A Beginner’s Guide to Globetrotting and
Healthy Travel: Don’t Travel Without It!

I’ll Bet You Do it Unconsciously

What is it that comes so automatically to nurses that we don’t even realize we’re doing it? You do it when you trainIMG_0194 your dog, select your produce, buy a new outfit, create a new budget, teach your children – and even when you fight with your SO.

What is it?

Here is a hint. It starts with assessment. Yep, its the nursing process – so let’s  pick a problem. I want to bond better with my Grandma’s dog and have fun with him by teaching him a new trick.

The trick I want to teach him is to jump through a large, flaming hoop. The dog is a nine-year old, tiny, Toy Poodle. But he can hear well and likes to obey to get treats.

Admittedly, he isn’t really big or agile enough to jump through a ring of fire – but if my catcher on the other side is super-able to catch the carefully tossed furball….

Oh no! That is a problem!

The diagnosis – What do you think? Do you like: “Knowledge Deficit – related to unrealistic and scary dog trainer!” ? Well, maybe you would word it a little differently?

Planning probably uses more brain cells than any other part of the process, and this is the part that pays off the most. You might consider using pamphlets, videos, or live demonstrations. You will obviously encounter objections and questions for which you will want to be prepared beforehand.

By the time you reach implementation, you are thoroughly ready for your well-thought-out teaching tasks. We discuss, cuss, and discuss some more. And then you have me try an easy (substitute) trick with said tiny dog.

IMG_0187Lastly, (and I use that word loosely) how did it work out for you? Your evaluation is where it is the most tempting to fudge or compromise.

For instance, some might say, “That’s good enough.” But it is also a golden opportunity to start over fresh for an even better result. (Or is that my OCD talking?)

That’s the thing about the nursing process. It never ends. Its a cycle – way of life – and can even be a way of putting some of life’s biggest problems into perspective sometimes.

The Nursing Process – putting into words, and steps, the things we already do every single day.

Want to find out more? Applying Nursing Process:: A Tool for Critical Thinking 7TH EDITION
and/or Nursing Process: Concepts and Applications


What Surprising Factor Drives Patient Satisfaction Scores?

Patient satisfaction scores RULE. Nurses are constantly being told to change aspects of their practice, in order to raise “those sacred scores.”

But what is the number one underlying factor influencing the scores that patients give?

Just to validate surveys for a second – most of us appreciate honest feedback. Even in personal friendships, we like to know if what we offer to the relationship is beneficial. Feedback gives us a chance to alter our future behaviors – or not.

Not surprisingly, because of their effectiveness, satisfaction surveys are widespread – not just for hospitals. Most businesses ask customers to participate in their surveys.

Why? Because the results are valuable to competition and business growth. Survey Monkey says its all about patients/customers receiving what they expect.Scan0004

Of course you know patients want to feel that you know them very well. They like for you to speak to them in plain language, and to make sure they really understand the content and how to apply it. They also want to feel your positive attitude and see great teamwork.

Am I saying that its all about YOU? YES! I am saying it is all about YOU.

You are the one they have to trust with their lives and well-being for 12 hours. You are the one they hope will get their medicine right, keep them safe, advocate for them, and promote their healing with knowledge, compassion and honesty.

They are trusting their lives to you. What an honor!

But what makes YOU feel positive and work well with your team? Had you thought about how much your own feelings about your work directly influence your patients’ perception of their own safety?

In other words, do you and your nurse managers realize how closely YOUR satisfaction is linked to your patients’ satisfaction scores?

Not surprisingly, according to Science Direct, a strong correlation was found between poor patient satisfaction surveys and burned out nurses.

Patients who had nurses who were exhausted and ready to quit gave negative scores. Conversely, patients cared for by nurses who found their work meaningful, gave higher scores on their surveys.

The bottom line seems to be that, “IF MAMMA AIN’T HAPPY, THEN AIN’T NOBODY HAPPY!”

In other words, if nurses are not happy, and no longer view their job as meaningful, the patients will sense it and feel less confident that they are getting the best care possible. Studies across the globe have found this true, as you will see in the article in thebmj .

So, for floor nurses and nurse managers alike, “THE SURVEY SAYS”: Patient satisfaction = nurse job satisfaction. Food for thought, eh?


Sources for this article:

Survey Monkey

The Profitable Practice

Science Direct

The bmj

For more information, see:

Love Your Patients! Improving Patient Satisfaction with Essential Behaviors That Enrich the Lives of Patients and Professionals
TIME to CARE: How to love your patients and your job
How to Survive and Maybe Even Love Your Life as a Nurse

Retiring Boomers – Want a Brain-Dead-Simple Plan?

Finances after fifty – yes, you have more buying power than any other generation alive. But here is what credit card companies and other lenders don’t want you to take seriously. In reality, this might be catch up time for many.

But who feels like dealing with it? When you’re short on time and energy, what brain-dead-simple retirement solution can you put into place FAST?

And where should you begin?

  1. First, decide to get serious about it. Start with what you know. Use the Nursing Process.
  2. Assess. Inventory your assets and debts. Include how much time and money you might have to pay to help your elderly parents. Remember Dave Ramsey’s asset calculator which is free for your use.
  3. Diagnose. How bad/good is it?
  4. Plan. Set a financial goal and a time frame in which to reach it. Remember that you might live longer than you expect.
  5. Implement.
    • Tweak things in your life to: make more money, spend less, and save/invest more.IMG_0078
    • Do you still need that big home and new car? Can you save more if you downsize and get rid of your monthly interest-charging bills?
    • Tell your family you will be cutting way back on holiday gift spending.
    • Prepay your funeral expenses. You certainly don’t want your grief-stricken, vulnerable loved ones to pay extra to a hungry salesmen at the funeral home – especially if you haven’t made your wishes known. (I wrote another article, called “What Motivates a Nurse to Prepay Final Expenses”, in May of last year, that you can check out if you want more detail on that.)
    • Decide if you should work extra shifts or take a second job for a year or two? Is there a hobby you love that has earning potential? Many Boomers are moving into business.
  6. Evaluate. Calculate your progress so far. (Like Dr. Phil says – “How’s that working out for you?”)
  7. Start over with another assessment.

Here is a great basic starting point: The Charles Schwab Guide to Finances After Fifty: Answers to Your Most Important Money Questions .

Many nurses have scoped out the other, less strenuous, jobs at their hospital and learned how to fill those positions when the time is right. Why Retire?: Career Strategies for Third-Age Nurses .

There are so many productive ways to keep busy and find meaning after retirement. Portfolio Life: The New Path to Work, Purpose, and Passion After 50 .

Many Boomer nurses dream of creating their own business after they retire from the hospital. Boomers into Business: How Anyone Over 50 Can Turn What They Know into Dough Before and After Retirement .

So, any person can do this – even if they feel brain-dead sometimes. Here is a way to make it more interactive: Quicken Financial Planner, QuickPlan Edition .

So you see? Boomer nurses’ retirement planning is so simple! Just do what you’ve been doing it all of your nursing career – using the Nursing Process.

What do you love? Go for it! Let your excitement for a bright new future come alive!


10 Prep Ideas for Retirement – The Working Years

Can’t wait to retire? Will you be ready? How much money will you need to live your dream-retirement? How long will it take to save enough money?


What are some tricks you can use to move you toward your goals during your working years?

Let’s get started.

  1. Learn how to start making your money work for you. Rich Dad Poor Dad: What The Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!
  2. In the meantime, work extra shifts – as long as it doesn’t interfere with your family or your health. Besides the money, it looks good on your performance review.
  3. Keep an eye on your 403-B or 401-K’s performance and the overall health of the country’s economy. Intervene only if really necessary.
  4. Daily, spend time day-dreaming about your desired retirement. The more you do, the more your subconscious prompts you to move you toward your goals. Think and Grow Rich: The Landmark Bestseller – Now Revised and Updated for the 21st Century
  5. Buy quality, and take excellent care of your belongings to make them last longer. 925 Ideas to Help You Save Money, Get Out of Debt and Retire A Millionaire: So You Can Leave Your Mark on the World
  6. Advance your own physical, mental, and financial health. Don’t allow dysfunctional people to drain your hard-earned assets. Boundaries: When to Say Yes, How to Say No to Take Control of Your Life
  7. Give to charities according to the way God leads you. Do not be coerced.
  8. Whenever possible, get needed surgeries and treatments completed before you retire. That way you get paid during recovery – with FMLA and/or PTO.
  9. Never allow credit card debt. If you have it, get rid of it fast. Rich Dad’s Advisors®: The ABC’s of Getting Out of Debt: Turn Bad Debt into Good Debt and Bad Credit into Good Credit .
  10. See the post just previous to this one. Do your best. Learn about money. Diversify your investments. Never stop dreaming.

A lot of nurses worry that job-hopping (common among nurses) might hurt their retirement goals.  Not as much as you might think! Just remember to always keep rolling your 403-B or 401-K over to your next job.

And if you do job-hop, you might consider travel nursing. You can even stay in your same city, the agencies offer more than all the usual benefits, and travel nursing generally pays a lot more than working for any hospital.

*****Do you want to use Dave Ramsey’s investment calculator for free? This Dave Ramsey article lets us do just that. Just go to his article and clicking the link there.

Dave Ramsey has also brilliantly written some good news about: Retirement for All Ages: A Planning Guide for Your Retirement At Any Age . He shows the steps to get you from where you are to where you want to be.

The recommendations here are from various named sources and from my experience. Verify before taking action on any of it. Hope this helps! What are some of your savings tricks?


11 First Steps: Retirement Planning Tips

Here are some of the things I did to sabotage my own retirement plans during the initial phase of my nursing career.001

Upon landing my first GN job in 1987, I was thrilled to earn $11.00 per hour! We had been struggling financially during nursing school – and it was finally time to celebrate! We started immediately on our “well-deserved” upgrades.

Meantime, student loans, from nursing school, would soon require monthly payments. With me as the only support for three people, I soon realized that our money left after bills was going to be less than before I landed that great job.

So, when a US Army recruiter told me we would get free housing, free medical, and my student loans would be deferred for as long as I was working as an Army nurse on active duty, I grabbed the chance.

I should have begun my early phase of retirement planning right then. But the starting salary of a Lieutenant – nurse or otherwise – was not much. Even after my two year raise, we were still struggling and getting further into debt.

We could have budgeted better, but we were stationed in Honolulu. We “needed” all of the Hawaiian things that other nurses’ families had.

Some friends worked another nursing job on their days off. But I had two kids, and we wanted quality time together. So instead of making money, we made (semi-expensive) memories.

What could I have done differently, and what strategies do I recommend?

  1. Don’t take student loans if you can avoid it. Work a job to pay for as much of nursing school as possible.
  2. Burn off your excess energy and frustrations by working a physically active job instead of paying money to go to a gym.
  3. Live with family or get an honest, reliable roommate – especially when you are a single parent. Even if they don’t contribute any money, you will still usually get free help with child care.
  4. Shop thrift stores. But watch prices and ask for better deals. Some will negotiate if you ask.
  5. If you have a neighborhood co-op near you, find out what tools, yard equipment, etc. you can borrow. You might be able to – say – borrow equipment, for free, to paint somebody’s bedroom for $100.00 in your pocket!
  6. Grow some of your own food – organically. You will save money – and nurses know the importance of eating healthy.
  7. Save 10% of each paycheck toward your one-year savings account to sustain you in case you are ever out of work for up to a year. And do not ever dip into it except for a true emergency.
  8. Start, the day each child is born, to save for their college.
  9. Deliberately live below whatever lifestyle your nursing income allows.
  10. If you want/need something big, save for it and buy it with cash.
  11. Never take on a car payment again, and make your current car payment your last.

I learned this from experience as a new nurse – and there are even more great tips in this terrific little book: 925 Ideas to Help You Save Money, Get Out of Debt and Retire A Millionaire: So You Can Leave Your Mark on the World This book will save you tons of money!

P.S. Its not that we nurse just for the money. But in order to pay our own way through life, we need to manage what we earn as well as possible. So, plan early – and live long!


Snakebit – Patients who Hiss at You

128px-The_Grass_Snake_-_Natrix_natrixWhat does it mean when a patient hisses at you?

Could it have been ICU Syndrome, mental illness – was he a terrorist – or maybe he was raised by snakes???

Ridiculous? Maybe – but here is my story.

I remember caring for one particular non-English speaking patient when I worked in the ICU at the county hospital in 1987. I was a fresh new grad – had not even taken state boards. Yet, I was being groomed in the SICU. So fun!

They let me care for extremely critical cases with all kinds of monitors, drains, and devices! It was a teaching hospital, and every day was new and exciting.

We got the rare and hopeless cases that other hospitals could not afford to take – because of their need to keep their scores high. We were not in competition. We accepted everybody. Nothing was too hard for us!

But this one angry patient was probably my biggest challenge in those days. He was in his early 20’s, slim, dark skin, black straight hair, and buck-naked. He violently refused to wear gown or covers. So there he was, day after day, wearing only his foley strap.

He was handcuffed to the bed (not unusual for our hospital), but nobody could communicate with him. His police guard didn’t understand his language any more than we did. Staff of various ethnic backgrounds also tried to understand his speech – but to no avail.

Communication was nearly impossible for staff – except for facial expressions and hand gestures. But he would make deliberate, angry, piercing eye contact, wriggle like a snake in the bed, say words I didn’t understand, and hiss.

Oh, yeah – and he would spit at us too.

My most memorable day with this patient was when his serum potassium level rose high enough to treat with Kayexalate – but he was NPO. Uh Oh. Not good news for him, for me, or for all my helpers.

I’ll bet you can imagine how many milliseconds he retained that enema. And – no – my flying leap was not fast or far enough!

After that, I had a couple of days off. When I returned this patient was no longer on our unit. Nobody knew what happened to him, and I never saw him again.

Not much later, I was recruited into the US Army to serve in Honolulu. New nursing job. New life. But, for a long time, I could still sometimes see those angry eyes and hear that sound in my memory. And I always wondered why he wriggled like a snake and hissed at us.

What was your most unusual patient encounter?

Here is something that might tickle your funny bone: Snakebit: Confessions of a Herpetologist



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