blue skies...

 another dull cloudless, blue sky day...haha!  the temperatures are a bit nippy...i'd guess near to below zero F. so chilly.  i got very little sleep and headed over to meet friends for the monday walk.  lovely as always.

 karen and maureen joined so that was fun, lena walked the track backwards and joined us about halfway. we took the stretch across the open area to enjoy the frost.  as long as it's not going to snow i shall revel in all the frost.  it is spectacular.

 in my haste to get out there i forgot my little camera and my wallet.  with two dogs, leashes, chuck it and gloves and all...the little camera is just easier especially when i walk with others.  the bigger camera's are easier for me to use when i can just totally meander and i'm not so sleepy.

 came home and took a much needed nap.  many good intensions to hit the pool.  a friend called and so we chatted instead.  so tomorrow pool, come hell or high water...whatever that means really.

 loved this one below.  will have to think of fun walk for tomorrow.  will probably settle rio in at home and just take blossom.  with it being this cold it's tougher on rio's paws.  she just seems more prone to frost bite.  she has booties, but her nails tend to punch through them so i should just buy another set again.  seems like an annual purchase.  dogs can get frostbite on their pads. rio has gotten mild frostbite before, blossom seems pretty much immune to any cold issues.

 my hands get chilly, but no frostbite for me.  at these temperatures one has to just be aware and plan your day and your wardrobe.

 maureen has changed jobs so hopefully we can get her out on occasion.  her little pup, kaya always seems to have a great time out with the big dogs. he's a cute dog...so photogenic.

 we ran into a few of our usuals out there on the trails.  i've met the same folks on these trails now for years and after seeing people over and over you start to get to know each other as you stop and chat.

 work went well last night.  we got our patients taken care of and were able to have time to giggle and chat a bit...always great.

 blossom looks crazy here with manny. below is kaya.

 the peds units are again attempting this bedside report which includes family.  i just roll my eyes as the powers that be attempt to convince us that this is to everyones benefit.  hate being handed a load of crap...just call a spade a spade.  i am not keen on including family in the nursing report.  there are many reasons.  funny thing is that management is trying to act like this will improve communication.

 i have taken some communication courses in my day and adding more people, more chaos and not having a comfortable and relaxing set up for communicating are actually all barriers to communication.

 families should be able to be more involved in the process, i think a better way is for rounds to be done at a consistent time and include the doctors, nurses and respiratory team.  really it doesn't benefit patients to listen to our report and because you have an audience you can't just speak freely and thus communicate easily. then there are always the social issues that can't be spoken about in front of family..they are the social issues. so now report must be split between chatting in a room with family and then taking part of the report to another area for the other part of report. it's pretty silly.  we all want to be "family centered" but the report between nurses is vitals and mucking that up like this is what causes the communication breakdown.

 they wonder why things are getting missed in reports and of course assume that nurses are to blame.  personally, i think the computer is part of the issue.  you put information into a computer and it's sucked into a black hole.  that is the issue.  it's really just much harder to retrieve the day to day nursing information.  as much as everyone hated the "kardex" it held a more updated version of what was needed.  it used to be part of our report to look at new orders, now we take a general look at this page of orders and if a patient has been in the hospital for weeks you can just imagine.  many orders now are written in notes within each order so those are totally easy to overlook.  i now have to go back and click on many of the orders and scroll through in order to attempt to find all those little notes.  that is why communication is breaking down.

 both my patients in the adult unit this week have had multiple surgeries, bronchs, scans, procedures...there isn't really a good format on the computer for seeing a synopsis of their stay.  many are resorting to reading through all the notes from all the various doctors and hand writing a synopsis of events of their stays and those get handed from nurse to nurse.  everyone is grateful when someone actually has time to do this and they can know what has happened. this is  good place to start to fix those communication issues.

 nobody asks me though.  they just come up with "solutions" to what they view as the cause of the problems rather than finding out what the actual cause is.  god forbid anyone blame the multimillion dollar investment called the computer...much easier to blame the nurses.

 have seen this lady out with her 3 dogs...very cute.  i'd always loved these long lean hunting dogs.  i know she said ones a borzoi and the other two are something else that i always seem to forget.

 frost and sunshine.  the crap that comes out of offices in hospitals will one day drive me away.  people who leave the bedside and take office jobs very quickly seem to forget the reasons we are here. it's no wonder to me why health care costs keep soaring.  keeping these people in jobs pleasing people  in other offices in other buildings is big business.  we would save tons of money if we just got back to basics, let nurses and doctors take care of patients and got rid of all the bullcrap.

 don't see that happening though.  the office space in hospitals grows bigger and bigger as the patient rooms get smaller and smaller.  i'm more and more convinced the people running hospitals forget that there are actually people who are sick and fighting for their lives in those tiny rooms.  it's pretty sad really.

 blossom had fun out there today as usual.  rio is snoring loudly as usual..

 no shopping, though i did window shop a bit over the weekend.  gotta start getting into the business of christmas.  easier to start with the cards. that gets me organized for getting packages together.  the sooner i get all that stuff done the sooner i can relax and enjoy the simple aspects of christmas like decorations, trees, music, kindness, spirit...the stuff that reminds you of what it's all about.  consumerism.  haha.

 slow progress on the book, but i'm not a very good home motivator.  just gotta plug along and things will eventually get done.  hard to not have a deadline and i can't trick myself into believing a deadline i make myself.

 doesn't look like the snow will be returning anytime soon.  will just continue to bundle up and enjoy all the frost.

have a good night.