The Real Nurse Jackie | McKnight's Long Term Care News & Assisted Living

Holiday gift ideas

Emily Mongan — Tue, 19 Dec 2023 17:00:00 +0000

As I was looking online for ideas for holiday gifts, I was stunned to see so many bizarre ideas are out there. I mean truly bizarre.

One I saw was a wool throw blanket that looks like a piece of meat. Now I know my friends in Kansas love their beef, but I cannot imagine any of them wanting to be draped in a flannel steak.

I saw an ad for a Christmas screaming goat toy. Now I find the YouTube video of the fainting goats hysterical, but I am sure I’d go insane if my grandchild was playing nonstop with a screaming goat toy.

Then I saw an ad for a set of holiday dad joke pencils. While my husband probably would love them, the rest of us would go nuts as he read them to us over and over and over.

And who wouldn’t want a set of “Jingle Butts” — hand blown glass ornaments that look like a person’s behind but in festive colors. I guess you can combine it with a set of festive beard ornaments. (Yes, that is a real thing.)

One gift that boggles my mind is the padded toilet seat. I mean, how long are you going to be sitting on the toilet? Do you think your legs are going to go to sleep? Hasn’t anyone ever talked to you about bran?

Then there is the assortment of flavored candy canes that seem just so yummy!!! Sour pickle flavored candy canes, ketchup flavored candy canes, sour cream and onion flavored candy canes, hotdog flavored candy canes, Dante’s inferno candy canes and bacon flavor candy canes. (OK, maybe the bacon ones would be worth a try.)

Of course, Hairball Kitty is a great gift because having a fake kitty hacking up hairballs is so much fun.

I read that an often-given hated gift is a diet book. Like seriously, a diet book when you have all this delicious, delectable holiday food. Who is cruel enough to give this as a gift? Satan?

The holiday drama emergency ambiance candle might be a good gift when your dinner guests start talking politics. However, the public toilet survival kit may be a gift I get myself. Yes, I suffer from public restroom anxiety disorder.

But the very best gift is all of you, who dedicate your lives to making this world a better place every day. Thank you for your sacrifices large and small, for your dedication, and for caring. That’s the best holiday gift ever!

Just keeping it real grateful,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real-life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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Sometimes all you need is a hug

Emily Mongan — Tue, 05 Dec 2023 20:20:43 +0000

I recently had the joy of spending a week with my 2½-year-old granddaughter. One thing that stood out to me was that when she was feeling insecure, she would say, “Mom-mom, I need a hug.”

Something as simple as a hug would bring reassurance that all would be OK in the world. And to be honest, having those sweet little arms around my neck brought me comfort, too.

Wouldn’t it be wonderful if we could give the equivalent of a hug to our “family” at work when they needed some reassurance? When you know your coworker is struggling with something or having a rough day, just find some way to bring them the warmth of human spirit to let them know you’ve been there and it’s going to be OK?

As leaders, can’t we also be a bit warmer, a bit more giving of ourselves especially in the season of giving to bring comfort and reassurance? A bit more sensitive to what others are going through, a bit more kind instead of the, “Well, she just has to put on her big girl panties and deal with it!”

I mean, wasn’t Buddy the elf (in the movie “Elf”) always asking, “Does someone need a hug”? OK, so it didn’t work out really well on the racoon but at least he’s asking.

And don’t be too shy to ask for a hug. Embrace your inner toddler and just ask. I promise if I ask for one, I won’t bite your face off!

Just keeping it real,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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Being thankful 2023

Emily Mongan — Tue, 21 Nov 2023 17:00:00 +0000

Ah yes, it is the time of year when we think about the things we are thankful for. I would guess that most people have some kind of tradition on Thanksgiving of expressing thanks.

In our home, we call it “Thankelfors” (my daughter came up with that name when she was about four and it stuck). Everyone around the table says at least one thing that they are thankful for.

But I need time to prepare. I don’t want to come out with something trite and, to be honest, I really enjoy meditating on what I am thankful for. Of course, faith, family and friends are always number one.

Shoot, I am thankful that my knees still hold out going up and down stairs, that I can lift my 30-pound granddaughter and not have an episode of stress incontinence, that I can balance well enough to put my pants on standing up. I’m thankful for indoor plumbing and extra soft toilet paper, good hair days, yoga pants, and coffee … definitely good coffee.

However, I think we really should be profoundly grateful for the profession we chose. D.L. Moody, an American evangelist known for ministering in the battlefield to both the Confederate and Union soldiers during the Civil War is quoted for something that to me at least, was life changing. He said, “Our greatest fear should not be of failure, but of succeeding at something that doesn’t really matter.”

What we do matters. It is a mission. It is changing someone’s life for the better every day. Whether our residents/patients or the staff we mentor. It has a profound impact in this world, even though almost no one seems to recognize that.

So, at this time of thanksgiving, I want to thank you all from the bottom of my heart for your devotion to senior care without any fanfare. Know that you are succeeding at something that matters.

Keeping it real thankful,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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Market it like a tattoo

Emily Mongan — Tue, 07 Nov 2023 17:00:00 +0000

I was driving and listening to the radio last week and I heard an interesting marketing campaign. Apparently, to get people to vacation in Acapulco, the city’s newest campaign to get tourists is to offer free tattoos. I kid you not.

I kind of think that someone who is really into tattoos would probably spend that money on finishing their sleeve rather than go to Mexico and get a random tattoo. But that is just a guess.

Then again, you always hear of tourists sampling the tequila and coming home with a tattoo they don’t remember getting, that is unfortunately, quite unforgettable.

This got me thinking about how we market working in long-term care. Kind of like someone talking to a couple thinking about marriage. “Well, it takes a lot of hard work. You have to be really committed. You can’t get complacent. You have to learn to get along even if you’re having a tough day…”

Wow, everyone will want to work with us when you tell them that!

Why don’t we market it like we would be telling someone about one of our favorite shows we watch. Like, “The people are amazing, they are so interesting, the history is incredible. You never get bored. It’s just exciting all the time. I mean no two episodes (days) are the same. And you just feel so good at the end of the episode (day) that you can’t wait for the next one!”

I mean, come on people, share the devotion. It’s why we fell in love with senior care in the first place. The good really outweighs the tough stuff, so share the wins and joys.

And by the way, where DID this tattoo come from? Just asking for a friend!

Just keeping it real,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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Quality does not equate to staffing mandates

Emily Mongan — Tue, 10 Oct 2023 19:17:45 +0000

I recently returned from the AHCA/NACL national convention and expo, one of my favorite conferences of the year. One reason why it’s a favorite is the recognition of quality in our profession.

There is a 90-minute awards session, recognizing Bronze, Silver and Gold Quality award winners throughout our nation. These are facilities who worked darn hard to achieve quality, measured results, applied for the award, were subject to immense scrutiny using the Baldrige process by a team of examiners, and were awarded for achieving quality. Definitely not an easy feat to accomplish.

There were 399 Bronze winners, 72 Silver winners and two Gold winners. Holy moly! The excitement at the award session was palpable. People cheering, standing, clapping, applauding, some crying tears of joy. It was incredible!

Now picture this: All of this amazing quality was achieved without having an unfounded, unfunded, unrealistic and unachievable staffing mandate in place. Wow (I say sarcastically), you mean people can achieve quality without meeting impossible staffing ratios? Say it isn’t so! Oh, you mean all those LPNs the government is choosing to ignore in the “study” actually impact quality!

So, while you are writing your response to the Center for Medicare & Medicaid Services (and make sure you do), use this link. Don’t forget to mention the quality that is achieved daily WITHOUT this stupid mandate!

Just keeping it real (and realistic),

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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Be consistent, and make them expect it

Emily Mongan — Tue, 26 Sep 2023 16:00:00 +0000

You would think that everyone would be aware of how critically important consistency is. It’s truly indispensable.

Take being a parent for example. When you have a two-parent household, being aligned is vitally significant. And within that alignment, you need consistency. I mean, as parents, we do our best not to mess up our kids, but I can promise you, if you are inconsistent, you won’t achieve that.

For example, let’s say you have a consistent bedtime at 9 p.m. It’s understood everything needs to be completed before 9 p.m. Everyone can get with the program. But if one night you say bedtime is 9, another 8, another 10, it’s just downright confusing. No one knows what to do, when to finish things, etc. It’s not fair to the kids.

Consistency provides a level of comfort. Even in statistics, a constant is an entity whose value does not change throughout the calculation. It can be relied on.

And here is something really powerful. Transformation happens when you do consistently what others do occasionally. Think about how powerful consistent good customer service is. Like, having a procedure where all leaders meet the new admission within 24 hours of the admission and it is a facility habit that you can count on. It’s comforting and transforms customer service.

What about consistent assignment? I never understand why everybody doesn’t do that. With consistent assignment your staff REALLY know the residents. Knows what they like, when they are having an off day, etc. That’s transformational.

But consistency should, however, be doing something good consistently. I had an employee once who said, “I’m very consistent. I come in late every single day!” That’s not so much what we want.

Or how is it so consistently hot in Hell? Good insulation. (I know: Dad joke!)

What do you call a knight with a consistent sleep schedule? Sir Cadian. (Nurse joke!)

OK, but bottom line, small things done consistently always trump things done occasionally. Be consistent in what you expect, what your procedures are, how you treat everyone and you will be an exceptional, transformational leader.

Just keeping it real,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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It’s painful — and there’s no end in sight

Emily Mongan — Tue, 12 Sep 2023 19:00:05 +0000

So here I am in Florida. I started having pain in my upper right gastric region. Over the course of three days it was getting really intense. Could my primary care provider squeeze me in? Nope.

So off I go to urgent care. I get there and it takes a loooong time for them to verify if I can be seen there (i.e. Will my insurance cover it?) as I am clutching my stomach with tears coming out of my eyes. They finally find out I can.

I was seen and the doctor says I need an ultrasound. After two hours on hold, I showed up at the radiology place to try and get an appointment. They say the soonest is two weeks. I explain I am going to explode, like as in the movie “Aliens,” right in this office. Suddenly they find an appointment for the next afternoon.

I get the ultrasound and the results two days later. My PCP says I need to see a gastroenterologist and get a test called an ERCP, ASAP. I call around to every GI office in a 15-mile radius. Soonest appointment? Three months. But, I try to explain, I am in pain, it’s emergent, don’t you all do emergency visits? All answers were the same: Nope, just go to an ER.

Well, I am not a gazillionaire. In addition to having to sit in chairs for half a day, I would owe a 20% co-pay of an ER visit. So, basically a few mortgage payments.

Can you imagine if we tried to get away with this in the skilled nursing facility? “Oh, sorry, sir, but your mom has to stay in pain and put her health at risk and wait three months to see a doctor.” Oh yeah, CMS would love that too. Let’s ignore F711, F712 Physician Visits and Emergency Physician Care F710, F713. Why not? And that’s besides the inhumane care.

So here I am, calling the doctor’s office every day, hoping there is a cancellation I can squeeze into before the alien pops out. As much as I am often bothered by regulations, I do wish they were applied fairly across all sectors of healthcare.

OK, I am getting off my soapbox to clutch my stomach again! Hopefully this is just gallstones or something else easily identified and dealt with. Until we find out, it’s liable to be pretty uncomfortable. But better than an Alien! Oh, the inhumanity!

Just keeping it real (painful),

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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Trying to reason with hurricane season

Emily Mongan — Tue, 29 Aug 2023 16:00:00 +0000

I’m here in Florida trying to prepare for this hurricane we are supposed to get as I write this. You know, you can do your best to prepare but as you’re scurrying about, knowing it’s hurricane season, you have to wonder if you can ever be really truly prepared.

I’m like, dang, why didn’t I buy that case of water last month, or fill up the Jerry can of gas for the generator weeks ago? I knew it was eventually coming. It’s the season.

And, of course, that got me thinking about trying to prepare for survey. I mean this hurricane we are expecting, it can be a tropical storm or a Category 4. It can head for us or curve and go to where we evacuated to (true story — it happened last year). For the most part though, I’m prepared. I have a generator, flashlights, days’ worth of non-perishable food, solar generators, evacuation plan… the whole works (except for the extra water, which we drank, and the gas).

But so many people start rushing about when survey is due instead of being ready all year long. And, yes, I get it. We don’t know if we will have seasoned, understanding surveyors or get hit with a curve and get slammed with contract surveyors who honestly don’t know an F675 from an F684!

Knowing that, we should always be prepared, we should always be auditing, evaluating, making meaningful improvements, etc. We should do our darndest to treat residents in place and give great clinical care so we have excellent outcomes. Good regulatory outcomes always follow good care.

I mean, unless you prepare properly, it’s like “Trying to reason with hurricane season” and, well, that’s unreasonable!

Just keeping it real,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Thick as a Brick

Emily Mongan — Tue, 15 Aug 2023 16:00:00 +0000

I was recently on a road trip, cruising along and listening to the classic rock station on Sirius XM. There was an interview with Jethro Tull’s Ian Anderson where he explained the title “Thick as a Brick.” Apparently, this is an English expression meaning willfully ignorant.

Mr. Anderson said this is where someone purposefully chooses not to accept facts or embrace knowledge but chooses instead to believe in whatever they wish to believe is “truthful.”

Kind of like people who choose to believe there is no such thing as climate change despite all the scientific evidence (as I sit here sweating in 108 degrees) and blame it on cow manure.

The thing is many of us in healthcare deal with the consequences of those who are “thick as a brick.” You know, the residents and family members who believe we can fly into their rooms within seconds of a call light going on, whenever it goes on. Or those contract surveyors who want to cite you on something that isn’t citable despite you actually showing them the ACTUAL regulation!

Or maybe it’s the government entity that thinks creating staffing mandates will make nurses fly out of your butt and money to pay for that too? Like you want to say, “It costs Dick $315 a day to take care of Jane. The state pays Dick $275 a day to take care of Jane. The government wants Dick to increase his staffing to an unfunded 4.1 nursing hours per resident day (HRPD). Dick is already losing $40 a day to take care of Jane. Dick thinks the government is as thick as a brick!”

But let’s be sure we don’t become willfully ignorant. Flu season is around the corner and that means vaccines for residents and staff. Let’s be sure to acknowledge years and years of scientific progress and evidence and protect ourselves, our families, and our residents.

Please don’t choose to believe some dude with $600 worth of video equipment and a YouTube channel. Don’t be “Thick as a brick!”

Just keeping it real,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.

Are you a good shepherd?

Emily Mongan — Tue, 01 Aug 2023 16:00:00 +0000

I think most people are familiar with Psalm 23. It’s the one that starts with “The Lord is my shepherd,” talks about walking in the shadow of death… you know, that one.

If you don’t go to church or synagogue, you still probably have heard this psalm in a movie or TV show. It is perhaps the most famous of all Psalms. I was recently reading it, and it got me thinking about sheep and shepherds.

And I am going to take the liberty of making a comparison of sheep being our staff and shepherds being leaders. No one should be insulted. You’ll understand soon.

I learned a lot about sheep. First, sheep wander, like really wander off, if the shepherd doesn’t keep watch of them. They will go off and do their own sheepy things.

Think of it as a poor leader not ensuring the staff have the appropriate education and skills they need to do their job. How many times have we rushed a new staff member to the floor when clearly they were not ready, but your excuse is that you needed a body (and then are surprised when they leave you within a month)? How many times has a corporation made an economic decision to let go of all the regional and corporate educators to save money? Do we daily lead and teach or do we just think that is something we can do now and then?

Sheep will actually wander off a cliff if they aren’t kept in the fold with the other sheep. Like, kumbaya oneness with the other sheep. Do we take the time to create a culture of “oneness” among our staff, so no one is off doing their own sheepy thing? Do we actually create a culture of living our mission, vision and values?

Did you know that a shepherd will leave the other sheep and go get the one that wandered away? The shepherd doesn’t say, well, I’ve got these 99 so that one can wander off. No, the shepherd goes after the lost sheep to help it. And let’s face it, sheep follow each other (kind of like lemmings). So, if you have one sheep going off doing its own thing, isn’t it a danger that other sheep will follow it? Go after that sheep, see what’s going on and bring it back in the fold. Maybe it just didn’t know you cared.

Next, did you know sheep won’t drink from rushing or moving waters? (I know, like, who knew?) Sheep need stillness and calm to drink. Sheep will hydrate by the dew on the grass, by still waters such as a pond or lake, and by water drawn from a well. Doesn’t that speak to us as “shepherds”? Daily, shouldn’t we be the dew that hydrates our staff? “How are you doing? How’s it going? Do you need anything? Good job with that.”

You should be the calmness amidst the “rushing waters” of daily life. No one can learn or be guided when things are chaotic. Lead your staff to still waters first, before you want them to learn something. Also, be that calming still water for them when they need to talk when they are unsure of something. Heck, be a human valium!

And yeah, sometimes you have to do the work of digging a well. You might be totally dry, got nothing to give, but you are their shepherd. So, dig deep, get to that water and be there for your people. You don’t want your sheep wandering away, looking for better waters down the street!

Just keeping it real,

Nurse Jackie

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

Have a column idea? See our submission guidelines here.