First, you work in one...

...then you live in one.

One of our volunteers has become a resident. Thanks to HIPPA, I can't tell you anything important, but I will say it's the saddest thing I've ever seen.

I hope that we can return the kindness that they showed our residents, now that they are one themselves. Even if we can only achieve one percent of what they gave to us, it will be a lot.

Ugh. I'm really having a hard time with my feelings about this. When I die, me and God are having words. I think most of mine are going to have four letters in them.

Saving them from themselves

The lines we walk in this industry are so fine as to be invisible.

If a resident wants to do something, but it's going to hurt them, how do we decide what's right? If it's not illegal or immoral, but it could result in injury, hospitalization, or death, do we have the right to stop them?

Smoking is a big one. If having a cigarette can result in respiratory arrest, can we forbid them from having one? Isn't it their right to smoke if they want to? Do we have the right to limit them or forbid them from smoking?

If the resident refuses a shower, but desperately needs one, do we have the right to force them in there and hose them off? If we don't, and they suffer from skin breakdown, is it then our fault because we respected their wishes?

How do we know whether what we're doing is abuse or just saving them from themselves?

"I'm cool."

We have some trouble with our computer that prints our MAR's (Medication Administration Records) and sometimes the order changes that are made don't stick. This results in us having to correct the MAR's by hand.

Now, we have standing orders for most of our residents for things like Milk of Magnesia, Maalox and Imodium. Well, for some reason, one of my MAR's says it can only be administered at bedtime. As far as I can tell, this is just a data entry error, but I haven't had time to research it and fix it. In any event, I have been known to give this resident a dose of medication after supper if they need it, but the other CMA's won't do it (although they know the order is incorrect, too) because it's printed that way on the MAR.

I got outed.

So, the other day, I told the resident, "When I break the rules for you, don't tell on me or I won't be able to get away with it anymore." (I am going to get this fixed this week so that it will cease to be an issue.)

"OK. I won't. I'm cool," they said like I might be giving them something illegal instead of just an OTC medication. I wanted to laugh. And then I wondered how many times in their life they'd said those very words and I laughed out loud. This job never ceases to amuse me.

It wasn't even a couple months.

Heck, it hasn't even been a month since I posted this http://ktreecna.blogspot.com/2009/03/when-overwhelmed-pick-tree.html
and talked about how I might be getting to know a new DON. Ours walked last night although it's unclear whether she went of her own volition or not.

In any event, the changes continue. Every day is a new adventure. At least I'm never bored.

Pain is what they say it is.

We're going through this weird thing at work right now where the DON wants every request for pain medication (even Tylenol) to be reviewed by the charge nurse. So, when a resident tells me they're having shoulder pain and it's a 5/10 on the pain scale, I now have to get my nurse to approve their pain medication. Which basically means the nurse goes down and asks the resident what their pain level is and tells me what to give them.

I've watched some of the nurses do their assessments. The residents always tell them the same thing they told me and generally, the nurse will tell me to give the same medication (assuming they have several to choose from) that I would have given. I do tend to err on the side of a stronger med, just because, if it were me, that's what I'd want my nurse to do.

Once in a while, the nurses will try to talk the resident out of taking a pain pill. I will never understand this. If the resident says they're in pain, why should we doubt them? Frankly, if the resident is in for Long Term Care (versus someone who's just there for physical therapy until they can walk out on their own), give them what they want. It's not like they're going to go out and drive or anything. And as far as addiction goes, I'm told by our Hospice nurses that you cannot get addicted to pain medication when you are actually taking it for pain. (I think it's a non-issue anyway just because we don't need to worry about these folks functioning in society.)

Pain is what the resident says it is. There should be no second guessing or talking them out of it. Give them their pain pill and let them feel comfortable, at least for a little bit.

Not Quite Recession-Proof (Negative Post Alert!)

Healthcare is a great field to get into because there will always be sick and injured people who need our help. However, even in a job where there are not enough warm bodies to fill all the open positions, we're not quite recession proof. In the last six months, I've seen the following cut backs:

• One less CMA on my shift. (Which increased my workload by 50%.)
• The reduction of our extra shift incentive from $50.00 per shift to $25.00 per shift to $0.00 per shift.
• We used to get our base pay plus a dollar extra per hour if we showed up for all of our scheduled shifts. They've now taken that extra dollar away from us.

I've got a job. They need me and my residents are always glad to see me. Still, that last cut made my gross pay nearly $100 shorter than usual and I'm having a hard time swallowing my indignation at the whole thing. I'll get used to the shorter paychecks. It's my confidence in my employer that will take longer to recover.

Good Inservices v/s Bad Inservices

We have an inservice twice a month on payday. Sometimes, they're good. Like the day I got retested for my CPR and First Aid certification. Sometimes they're nothing but low-level donkey barbecues that I wish I could avoid. Unfortunately, there's no way of knowing in advance what we're going to get.

A good inservice should include:

• new information we might need to function in our jobs
• a refresher or testing on an aspect of our jobs
• maybe a reminder about some things that we've let slip
• kudos for the things we've done well

Any criticism should be done in private between the DON or ADON and the employees directly involved. Throwing this kind of stuff out in front of the entire Nursing Center staff is counterproductive. We should leave an inservice feeling good about ourselves, ready to make improvements and utilize any new information we've been given. We shouldn't leave feeling persecuted, frustrated or depressed.

War Wounds and Battle Scars

One of the ladies commented on my arms the other day.

"I wish my arms were nice like yours."

"Really?" I said. "I've always thought they were kind of hairy."

"Not that. Look how smooth your skin is. And look at mine." Her arms had age spots and bruises and her hands were thin-skinned and veiny.

"Oh, that's just part of growing up." I said.

And, as usual, I thought of a lot of better things to say after that.

Like: "Those are just your war wounds and battle scars. They're proof that you've 'been there and done that'."

Or: "If everyday above ground is a victory, those are your purple hearts and merit badges."

How about: "And you've worked hard to earn everyone of those. That's just a road map showing where you've been."

I know, when it's my turn to watch my skin change, I probably won't be happy about it, either. Maybe I'll wish for my young skin again. But I hope not. I hope that I'll recognize it for what it is: an old, patched jacket that shows that I have, indeed, "been there, done that, and got the t-shirt".