You Gotta' Laugh

My final post relating to nurse surveyor burnout is to say that we just need to laugh at ourselves. Laughing is the best medicine. You wouldn't believe the silly humor that goes around a hospice office. The office is where we can be sarcastic and off-the-wall with our comments. We are among friends/colleagues. We have all been there and we all understand that we are not alone in this nurse "thing". Nursing is different from almost all other career choices, including any other medical position. I think it is kind of like being every one's mom rolled up with plenty of smarts and savvy. We are silly, but in the instant a patient needs us, we turn into lean-mean nurse machines, yelling "here we come to save the day, Mighty Nurse is on the way." Watch the following YouTube video that seems to be a "mockumentary" on nursing burnout. After you laugh awhile, pick yourself up be the seat of your pants and keep walking. Tomorrow your heart will be melted by the sweetest compliment you've ever received from one of your patients. Or maybe you'll hear the words, "What would I ever do without you?" In other words, it is worth every ounce of energy, long hours, study, exhaustion, and tears to stand up and proudly say, "Hi, I'm going to be your nurse today."
http://www.youtube.com/watch?v=6_D29DnH0Q0

Burn Out Continued

Burn out can take on several forms. In the last post, I discussed the long learning curve involved in becoming a surveyor. This can be very discouraging and it is especially ego-busting. Most nurses are high achievers and not being able to pick up this position and run with it in just a short time frame just sits sourly on your stomach. You may have been accustomed to receiving accolades from your former employers, patients, and maybe even peers. It won't happen in this job. Just learn to deal with it and realize it is not personal. This job truly difficult to learn and different than any other position you may have ever held.

After a couple of months, you will begin to feel pretty confident in your skills at performing the survey. You will also have a stronger grasp on the regulations by this time. This may be a delusion. Really. Close to the time the agency is ready to let you go out on your own (which is several weeks after you attend the federal training), you will begin to write the survey. All your confidence gained over the last few months of continued training and following other surveyors will probably go bust at this time. There is a quality review of the surveyor write-up of observations. The QA nurse is very experienced and knows the proper way to document all the regulations, tags, and conditions of participation. You may feel that you have been chewed up and spit out before the process is complete. Let me warn you, feelings of doubt about your skills as a nurse will come into question! Let me clarify. These feelings will be self-inflicted. Again, being a high-achiever, critism comes at a price to our egos. You may at some point, be the brunt of a tirade by the QA. Again, you must learn to take it and realize...this is a very difficult position and is unlike any other you may have had in the past. This seems a good place to stop for the day. Depressing? Only if you don't take it as truth. There truly is no need to beat yourself up. You will survive. I'm trying to warn you of the pit falls so that you won't be surprised and so you may develop coping techniques to get you past these bumps in your road to becoming a successful nurse surveyor.

Surveyor Burn Out

As unbelievable as it may seem, you will reach a point in your new career path where you ask yourself it it is the right job for you or if the low pay is worth it. Some of us hit this small bump in the road sooner than others. I would imagine there are some that hit it more frequently than others. But, the simple truth is that you WILL indeed hit it at some point. Being prepared can help you get around this.

My personal bump came about 4 months into my journey with the regulatory department. Several things contributed to this. One was that some of the benefits of having this particular position were based on being able to receive various monatary rewards related to certain benefits provided by working for the goevernment. Many of these have been widdled away at in the past 15 months or so since the recession hit. This meant the same amount of work, for less actual money. That would have been more tolerable if I had not been the single sole bread winner in our household.

On top of this, I learned the very hard truth that while I may have picked up on other jobs I had done very quickly and easily, this was not the case in this one.
Now, this was messing with my job satisfaction. I actually became fearful of being fired because the supervisors obviously thought I was the dumbest nurse they had ever hired. It took awhile before I began to believe them when they told me I would not feel truly comfortable in my job for about a year. I have now passed that point and have learned it is absolutely true. At some point, a light bulb came on and I suddently began to feel confident of my knowledge.

As I said, this was different from any other position I had held. I am pretty much a straight A student with a type A personality. The more you tell me I'm doing great, the better I do. The more responsibility you put on my shoulders, the happier I am. Just let me know you appreciate me and I'll do back flips around everyone else.

That is far from what this job feels like. Today, for instance, I had the audacity to feel a little smug that I was getting the task of writing the survey results pretty well when, boom, there was an email from my supervisor telling me not to get complacent. I'm still making errors. Ouch!!

Because of this unique position and the unique learning curve, I am going to spread this topic across 1-2 more posts in the next couple of days.

Hospice Care and Regulations

http://www.youtube.com/watch?v=goq2j511MqY

The above link represents an effort by the major hospice and palliative care organizations to educate the public on what hospice and palliative care actually mean. It is important that the nurse surveyor understand the mission and goals of hospice prior to attempting to survey the hospice for regulatory compliance. Once you realize the purpose and goal behind the hospice movement, the regulations make more sense to you. The regulations become your mission to ensure those who have reached this difficult time of life, receive all that hospice is intended to be. Enjoy the film. There are lots more out there, if you are interested.

Home Health Nursing

Today, I thought it would be interesting for you to see how regulations actually affect the home health agency. The video you will watch is of a hearing with CMS and a small business owner of a home health and hospice agency. One thing it is important to remember when we survey any agency is that they usually want to do what is best for the patient. I think you can relate to some of the issues this RN brings up about some regulations that affect agencies, especially smaller ones. We need to enter respectfully and with the expectation that the agency staff tries to give good, high quality patient care. This video will just give you some food for thought.

http://www.youtube.com/watch?v=stEPx3igAZA

Communication, Critical Thinking and Survival

Hello! Today I wanted to try something a little different. I am attaching a link to a YouTube video made that discusses survival of all nurses, not just surveyors. This is important information no matter what your job or where you work.

OK, uploading it from the YouTube web site did not work for me, so please copy and paste the following web address to view the video. Thanks and enjoy!

http://www.youtube.com/watch?v=xrVF8D8axGI

Orientation

Orientation, on the surface, appears to be excellent because you are given several weeks to complete it. Don't let time be equated with quality! What I found was that you are given, on day 1 usually, numerous packs of information along with some empty (albeit used) binders. You are told to divide the inforamtion up (which is given to you in rubber bands or some other form of division) and place each subject matter in a binder. Believe me, reading these various binders is time consuming (thus the length of orientation) and mind boggling. There will be a lot of repeated information. There will be a host of acronyms that you are unfamiliar with. (Keep the acronym list handy for reference.) Put aside, as priority study guides, the S.O.M. (State Operations Manual). This is the Bible of regulation. The next most important binder is the home health federal and state regulations. This is dry and repetitive reading. The most important part for you to focus on at this time, is the definitionss. Each of these definitions defines how multiple regulations are interpreted. And, please note that while the federal regulations do have interpretive guidelines to assist in the interpretation of the regualation, state does not. Many of the state rules are similar or exact to the federal regulations. However, you cannot count on that. For instance, state patient rights is more restrictive than the matching federal regulation. In this case, you must judge all patient rights based on our state rules.

Your first survey's will be involving home health agencies and you may start to survey those agencies who are registered as State License Only (SLO) prior to going to the federal training. You will survey federal home health agencies with another surveyor until you have attended this training. Once you spend the week training with the feds, you will be required to go with another surveyor for a few more home health agency surveys while they check you off on your survey skills.

Hopefully, having some of your orientation spelled out for you will ease some anxiety.

Organization is Key

Organization of your work space, reference material, office supplies, special forms, and a multitude of other items accumulated during your orientation is key to your survival. At this time, having been through your first week of orientation, you have learned that you either already have or will be receiving an enormous amount of information in a very short period of time. The way you organize this will influence your ability to succeed.

When I started, I was given a box and about 10 3 ring binders. Those binders were filled with various training materials that I had yet to understand. Later, after about 3-6 months of employment, I came to realize that many of these items were duplications that were given a different times in my training cycle. This may have been helpful to the trainer, but not necessarily to me. If possible, early on in your training, begin to review what you have been given considering where the duplications lie and why they are duplicated. It may be to teach you that the Federal Regulations for Home Health are needed at 2-3 different points in the process. The question is, why have so many copies of the same thing?

Here is my first real helpful piece of advice. Take one set of the Federal and State regulations and rules and set aside a binder for home health where you can put these. Place at the front of this binder, the cross-walk listing regs with both federal and state numbers. Behind this, place the federal regs and then the state regs. Put each sheet into a sheet protector for this will soon become your bible. Take this binder with you to all surveys, including during orientation.

That is enough information for one day. Do this early on in your studies and it will prove to be an invaluable tool. Having to look in too many places and through too many different binders, on the other hand, can frustrate you beyond measure.

Hope this helps.

Nurse Surveyor offers Survival Tips

This past Monday, I was finally taken off the "new kid" list at work. They have hired a new employee in my department. I work for a state department of health in the role of public health nurse surveyor. I came to the job with 38+ years of nursing experience, 10 of those in the home health and hospice field. I was the Clinical Director. It was a hard, demanding job. In retrospect, it now appears relatively simple in comparison to my current position.

I'm sure that on today, her 2nd day on her new job, she is feeling a little overwhelmed by the enormous amount of paperwork involved, all the reading and watching of computer learning programs put out by the CMS (Center for Medicare and Medicaid Services). I want to offer her help and hope that this blog will eventually be incorporated into the orientation and training program in my state. (Please note that I am not mentioning which state I live in so I don't worry them.)

What you will find within the pages of this blog will be help, encouragement, and hope. After a year on this job, I can tell you it has been the most difficult job I have ever had in my experience. And I've done it all.:) But you will find we are a close group. We only see each other 2-3 times a year usually, but each of us would do anything for the other. We have developed a multitude of helpful aids and shortcuts, ways to increase time management, and otherwise handle this job that I will share with you during the next few months. For now, welcome and best of luck!