Last week I described being warned not to make trouble by reporting the nurses watching the baby camera while at work. I've been thinking about that. Why would I be the troublemaker for reporting someone else doing something wrong? Shouldn't it be the other way around? You would think the person bringing it to attention would be thanked. I ...

There has always been some conflict between therapy and nursing. Each complains about what the other does or doesn't do. Last week I saw something that floored me. I went into the nursing office looking for a chart. I didn't find the chart. I did find three nurses watching someone's grandson through a web cam feed at his day care. It was on the ...

No matter where I am, I hear the old school/new school discussion. In simplest terms, it's a comparison of how we did something years ago compared with how we do it now. In more unkind terms, it can become a condemnation of those who went to school back in the day or new graduates. It came home to me how different the thinking is last Friday. I ...

Anyone who reads my blog with regularity knows the last year has been a struggle for me. I lost my beloved job. I was fired for being ethical. I encountered more than my share of unethical and self-serving people. During all of that, I hung on and kept going to work. Every so often I made a difference to someone, which kept me going. For the ...

This morning I was involved in a discussion about getting the most minutes from each patient. This can be taken two ways. Financially more minutes translates into better reimbursement. Therapeutically it results from the belief that every patient should receive as much therapy as possible. If one were to be charitable, you could argue the ...

I'm a peer reviewer for the Texas continuing education program. I review submissions for neuro, geriatric, acute and general so I get to see a lot what is being proposed for continuing education. Texas has a specific form that must be completed for each course submitted for review. It includes speaker qualifications, specific goals, a statement of ...

This morning there was a patient on the floor so the request went out for lifting help. Four people responded, including me, a PTA, a male CNA and the patient's nurse. The patient was a big man, weak and in a narrow space so it wasn't going to be easy. As we were positioning ourselves to lift him the nurse stepped away. She said she didn't lift ...

This morning while I was walking a patient, I overheard another patient walking behind us. She was telling the CNA taking her to the dining room that she recognized me from the weekend. She was upset with me because I came to take her to therapy and she refused. Her daughter was coming later that day and she didn't want to get up. I don't know ...

Last week I questioned what the definition of skilled therapy was. I had worked with several patients the previous weekend whose only deficit was the need for supervision. I've realized I wasn't clear in describing those patients. All of them had been on caseload for a while. Previous safety issues, such as Berg and Tinetti scores, had been ...

I've been noticing a disturbing trend lately. More and more facilities are considering the need for supervision as a need for skilled therapy. Back in the day, patients referred to SNFs and outpatient had an obvious need. They had trouble walking. They couldn't transfer. They'd recently undergone total joint replacement. The knowledge and skill of ...