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  1. Final countdown

    Nearing the end of my time in this RN Case Manager job.

    It’s a daily struggle to force myself to say “This cannot be my problem anymore”. 

    • Uncontrolled diabetes and living with caregivers who may or may not be correctly dosing, if at all, insulin and checking blood sugar levels twice a day?
    • Just found out from this physician that this person hasn’t followed up for scheduled appointments in almost a year?
    • This person left the nursing home against medical advice, before her therapy was complete, to live with her daughter with a history of financial exploitation of her own mother and keeping her locked in a crack house?
    • This person may or may not be filling her medications at one of 3 pharmacies and may or may not be taking them correctly because 2 of the medications have very similar names but are for very different diagnoses?

    All of these things and more. Cannot be my problem. 

    All I can do is write it down and offer advice for follow up to whoever is taking over this case in my absence until the new nurse is hired. 

    Can’t be my problem, but I can sure continue to stress out about it. Because when you’ve been working with the same clients for 5 years, you get a bit emotionally invested in their well-being. You know those clients inside and out, all their behavior patterns, the best approach for their caregivers, how to follow up with their doctors for the best response. Long term care is intense and you can give all the advise you want to the new nurse, but the new nurse is still basically going to start from scratch. Because the new nurse doesn’t know that client. But s/he’ll learn. Hopefully.

  2. How to Turn Every Single Thing Into a Nursing Assessment, by Sarah

    "The member demonstrated his ‘Irish Jig’ for the RN during the assessment, shifting his weight from one foot to the other, with no balance issues, and was able to transition from the quicker movement back to his baseline gait with no difficulty."

    This is my case note for when my members make me die laughing. 

  3. Procrastination

    Going through things, prepping to move. Came across all of my notes and powerpoints from Nursing School in a suitcase. All of them. So of course now I’m reading through slides on hemodynamic monitoring and the different stages of shock and the Conscious Sedation Independent Learning Project.

    I’m totally going to have that nightmare again tonight about showing up to class and finding out there’s a research paper due that I didn’t even know about.

    I know, I know. You understood some of those words.

  4. Schafer, Kathleen N., Janet R. Sawyer, Audrey M. McCluskey, and Edna L. Beck. Medical-Surgical Nursing. 3rd ed. St. Louis: C.V. Mosby, 1964. 

    Schafer, Kathleen N., Janet R. Sawyer, Audrey M. McCluskey, and Edna L. Beck. Medical-Surgical Nursing. 3rd ed. St. Louis: C.V. Mosby, 1964. 

  5. Possibly my best assessment to date.

    1. Me: Can you tell me who the president is?
    2. Client: Barack Obama.
    3. Me: And who was president before that?
    4. Client: George Bush.
    5. Me: And before that?
    6. Client: Clinton?
    7. Me: Yup. And who was before Clinton?
    8. Client: Umm... It was... Jeffrey Dahmer?
    9. Me: Did you just say Jeffrey Dahmer?
    10. Client: Hahaha yeah.
    11. Me: I really hope he wasn't president...
    12. Client: *laughs hysterically*
  6. When we get a new enrollee, we have to make face to face contact within 10 business days. The first, second, and third attempted visits failed. We are on the last business day. We haven't been able to get in touch with this guy ever. We've only been able to talk to his mom on the phone...

    1. A: His mom's phone is shut off now. Should we just stalk his house for a while? We don't have a number for him.
    2. B: We know he works at [Place].
    3. A: Ok. There are 2 [Places] in Milwaukee.
    4. *Call them. He just left*
    5. A: Ok. So now we know where he works.
    6. B: But he's not there.
    7. A: He could be anywhere.
    8. *Look through many many documents from county*
    9. A: Oh! He's in Daily Living Skills with [company]!
    10. *Call. No answer*
    11. A: Huh.
    12. *more spy stuff*
    13. A: Ok, as far as I can tell, he doesn't have a Facebook page.
    14. *One hour later*
    15. B: I was able to get a hold of his step dad. He doesn't know his cell phone number. He said he goes to Special Olympics Basketball after work, but he didn't know where they practice.
    16. A: Ok. Maybe try calling [Person] from [Group Home]. He also coaches Special Olympics Basketball. He might know.
    17. B: Maybe we should quit this job and start a private investigation business.
    18. *The adventure continues...*
  7. Today

    Today the case manager and I went to a client’s home for a care plan review. While there, she told us her daughter’s cat just had kittens and they didn’t even know the cat was pregnant. She led us into the bedroom where this cat was laying with five tiny balls of fluff that couldn’t even open their eyes yet. Three days old.

    And we both thought, “Why is her daughter’s cat here?”. “Who is going to take care of these fucking kittens?”. “Oh great. That cat’s been outside often enough to make babies and now probably has fleas everywhere.”

    And that is what happens to your brain when you go into Social Work.

  8. Today, while taking blood pressures for State Fair goers…

    "Your blood pressure is 168/109. You should probably follow up with your doctor within the next few days to have it rechecked and to talk about hypertension."

    "It’s fine. It’ll go down."

    Yeah. Ok. Enjoy your deep fried snickers with a side of stroke.



    In case anyone was under the delusion that “healthcare reform” was going to make people healthier.

  9. I am a volunteer guardian with the Legal Aid Society. I have one ward. My ward can’t talk, but has a giant smile. She lives in an apartment with 24 hour supports. She loves Reese’s Peanut Butter Cups. She made me a very glittery box for Christmas which makes my bedroom floor beautiful every day. She loves dancing. She has Down Syndrome. She also has a rep-payee to manage her social security income, pays her rent, gives her caregivers money for groceries and clothes and outings, etc. And, until she got that rep-payee, she had a family. She still has a picture of her family hanging on her wall.

    I am the legal guardian for someone who’s family abandoned her as soon as they were no longer able to control her money.

    Let me rephrase that.

    Some people took advantage of someone with a severe disability until she was no longer serving a purpose for them.

    I became a volunteer guardian because half my case load has a similar story and I figured I could provide more than case management to at least one person.

    A huge percentage of my clients have family in their city, a few miles, some a few blocks away, that never sees them. They live in group homes or supported apartments. Their families stopped having anything to do with them when they got rep-payees. Or they found out they couldn’t get paid to be a caregiver 24/7 for their family member who sleeps 8 hours a night and goes to daycare 7 hours a day and doesn’t actually need 24 hour supervision. Or realized they could get more money by claiming a bullshit disability.

    It’s disgusting.

    I don’t care what your life or situation is like. If you can’t be bothered to make any kind of contact with your brother/sister/daughter/son/niece/nephew/etc even through a generically signed holiday card once a year unless there’s some kind of profit in it for you, you are a worthless piece of shit that doesn’t deserve to live, much less live off of my tax dollars that could be going to people that actually need it. People that you threw away.

  10. My name is Sarah, and I am a Registered Nurse working in Case Management.

The key word is “working”.

No, really.

    My name is Sarah, and I am a Registered Nurse working in Case Management.

    The key word is “working”.

    No, really.