End of Year Review

So this is it. 2010 is soon to be left to the history books and 2011 is ready to take it's first breaths.

The most important question is "What did I learn this year?" because if you ignore the past, you are doomed to repeat it.

1. Fear is a lousy basis for decision making.
2. Slow down.
3. Listen.
4. Ask questions if you don't understand.
5. Taking breaks with a resident is good for you and the resident.
6. Taking breaks away from the residents is good for you and the residents.
7. Taking breaks away from your coworkers is not a bad idea, either.

The second most important question is, "What are my goals for next year?" because floundering through a year without a purpose is a waste of a perfectly good year.

1. Go back to working the floor versus working in the med room.
2. Take more breaks with my residents.
3. Take fewer breaks with my coworkers.

Have a happy and safe New Year celebration. See you next year.

How about we reconnect our frontal lobes?

You may (or may not) have noticed that I blog in the mornings. It's not because I go to bed right after work. I'm generally up until one or two in the morning. It's because I need time to let what has happened marinate and filter through my mind before I write it. Sometimes it helps me be less judgemental and whiny on this blog. I hope I haven't been too much of either one of those. There's more than enough of that crap out on the Internet already.

That being said, can I complain about my nurses?

Sometimes, it's better not to say the first thing that rolls through your brain. Not everyone is brilliant on the first try. Better to take a deep breath and consider your words before you spew them into the world for everyone to see.

I had a resident with diarrhea last night. It was messy and smelly and embarrassing for the resident. It took nearly 20 minutes to get her and her room cleaned up afterwards. Toward the end of this, as I was taking the trash and dirty clothes out of the room, a nurse walked in, wrinkled her nose and said, "Eww. Who is that?"

Really?

My response was to sigh, grit my teeth and say "It's Mrs. A. Her stomach is sick."

I sometimes wonder just what my nurses do in their free time that causes their lips to become totally disconnected from their hearts. Do they not think that the resident already feels bad enough? Do they not think that the resident knows how bad it smells? Would not the proper, more "nurse like" response have been, "Who's sick?" or "Did someone have diarrhea?"

So, a call to engage our brains before we put our mouths in gear. Think before we speak today. And may we be forgiven for the hurtful things we've said that we didn't even realize stung the victim.

Holiday Gifts

The policy at our facility is that we cannot accept gifts from the residents or their families. We're not even supposed to take food from them if they offer it. I hate telling them that I can't accept their offers, so sometimes I just take what they give me and turn it in to Social Services. Sometimes, if it's just a piece of candy, I'll take it. Fire me. It makes them feel good and keeps them from eating the whole box themselves, so I think it's worth the risk of getting in trouble.

So, I turned in a gift card one of the resident's had given me. I suggested they call the daughter (who had bought them) and tell her we can't accept them and ask her if she wanted to donate them to the facility and not tell the resident because I didn't want their feelings hurt.

I got a call today saying I could come in and pick the gift card up and keep it. Apparently, the daughter had bought a bunch of them and only two of us turned them in. Since the facility "didn't know what else to do or who had gotten them", the two of us who were honest about it are getting them back.

I'm not sure this is exactly how it should be handled, but there it is. And I need some jumper cables for my car, so that's what I'm going to buy. That way I'll be able to get a jump when I need it for old Pearl this winter which will keep my attendance good and that benefits the facility, right? Or that's how I'm justifying it to myself anyway.

Really?

Full Moon.
+
Total Eclipse.
+
Winter Solstice.
+
Unusually warm weather.
+
A death in the facility.
----------------------------------
A shift I may never forget even
though I'm trying desperately hard
to do so.

Today will be better.

Brief Hiatus

I'm taking a little vacation from the blog for a week or so. My sister's coming to visit me and I have my hands full getting ready and then will be busy while she's here. I should be back with stories to tell and opinions to foist upon you after the 19th.

What are they in for?

Yes, sadly, another prison reference. But a valid question. When we get a new resident, I want to know why. Are we getting them well enough to go home? Can they not take care of themselves, so are in for a long stay? Are they just here to die?

I'm surprised at how many times I ask a nurse this and they answer me with, "I don't know."

How can we effectively take care of a resident if we don't know what they're in for? Going back to the prison thing, you can bet the warden knows what each of the inmates is in for. They need to know in order to effectively house and, possibly, rehabilitate the inmate. I argue that we are in the same lake, if not the same boat.

I intend to start being more proactive in this. If the nurse doesn't know, I'll go and read their history myself. I may just be a pill pusher and a butt wiper, but I think I can do both jobs better if I know what the goal is.

Belated Happy Thanksgiving and Other Stuff

Happy Thanksgiving! Late though it is. A virus hijacked my computer and I had to wait until Friday to get technical support to help me fix the last little thing that the virus did to my computer. All should be well now.

***

So, here's the quote of the day from Thanksgiving:

"What are you doing?" Mrs. A asked the young aide.

"Oh, nothing," she replied.

"Well, that's about what I'd expect out of you."

And another:

"Honey," Mrs. B called the aide over to her with a wave of her hand.

"What can I do for you?" she asked.

"Tell me something. Are you as crazy as the rest of us here?"

"Yes, ma'am, I am," the aide answered.

Diagnosis

I was in Mrs. A's room last night. She told me Mrs. B was confused. She thought she was at home and wanted to go check on the horses. She said she had told the nurse and the nurse said they would come and evaluate Mrs. B.

"I can evaluate her for you right now," she said. "Cuckoo."

Why not take them home?

I sometimes wonder why some of our residents are in the Nursing Home at all.

We have family members who never seem to leave. While this is great, and the resident seems to love it, why not just bring them home? If they have time to be there all the time and diddle around making arrangements to have other people come in and be with the resident, why not do this at home where it's cheaper and the resident will be happier and more comfortable?

I think it's great when the residents have lots of visitors. I'm glad we have family members who check up on us and make sure we are on our toes. But if they have time to be with the resident 12 to 16 hours a day, they need to take the resident home and arrange for home health care to come in and assist them. It's a healthier and less stressful environment for the resident and it's healthier and less stressful for the family members, too.

Between and Rock and a Hard Place

UTI's are the bane of my existence.

I know what we're supposed to do to prevent them. Toilet the resident's regularly, do proper perineal care, offer them a drink at every opportunity, yadda, yadda, yadda.

But what do you do when you have a resident on a fluid restriction? I know from personal experience that keeping yourself clean and voiding regularly don't work very well if you can't drink enough fluids to flush out your bladder. Granted, these folks are usually on a diuretic of some kind, but it still seems like we're constantly poking antibiotics down some of them. No sooner do we get one infection cleared up than we have another one in the works.

I realize that this could just be the result of their other diagnoses (immobility due to hip fracture, diabetes, bowel incontinence, Multiple Sclerosis and other neurological conditions), but it's still frustrating when you try to do everything right and the resident gets sick anyway.

I suppose it's up to the physician to determine the optimum fluid intake that will allow the resident to remain UTI free and also out of danger from CHF. Still, I'd like to have a meter that tells me that the resident is properly hydrated without the guess work. Maybe I'll invent one after I create that teleporter that allows me to just show up at work instead of having to drive there.

Last Night in a Nutshell

I walked out of Mrs. A's room to find Mrs. B standing at my med cart with her hands on my pitcher and water dripping down her chin.

"Rita Lee! Did you just drink from my water pitcher?"

"Yes. Heh, heh, heh."

"Well, here's some more," I said as I handed her a cup of water before rushing back to the kitchen to wash my pitcher.

Funny how we get conditioned...

...to a thing and then react the same way regardless of what is actually happening around us.

***Whiny post warning!***

We've had several DON's since I began working at the Nursing Center. I usually refer to inservice as our "bi-monthly flogging". This is because the other DON's used it to tell us everything we had been doing wrong and to generally make us feel like we were the worst Nursing Department to ever exist.

I'm not saying that this never happens now. When it does, it's usually the Administrator running it. (Can I say that I don't like her and I'll be glad when she moves on to bigger and better things?) But, generally, when the current DON is in charge, it's more of a discussion of things we could do better than a "Hey, you losers, this is everything you've done wrong for the last two weeks" kind of meeting.

And yet, I still cringe when I have to go to inservice. In fact, I have often thought I would gladly give up my Medication Aide certificate just so I could be working the floor instead of sitting in there with my head bowed.

The worst is having to go to inservice on my day off (like today). It cuts my day in half. I spend the first half fretting about what's going to be said to us and the other half wondering why I keep going back if nothing I do is right.

On the bright side, I will get paid. And then I can grocery shop, which I LOVE to do. And if the DON is running it, I might actually get a suggestion for something I could do better instead of lash marks across my back.

Backhanded Compliment

Conversation at supper yesterday:

"Well, you look neat," Mrs. A said to me.

"Thank you," I replied.

"She always looks clean. She must shower," said Mrs. B.

I wish I could have thought faster. I would have said, "Yes. Once a month whether I need it or not."

Everything old is new again

I'm seeing a lot of familiar faces in this current round of hiring. While I am happy because there will be much less training time involved, I have to wonder why you would leave a place and then come back to it. I could understand if we had a new DON or Administrator, but these are the same folks that were running it when these employees left for greener pastures.

I see a lot of this here. Maybe it's because this is Small Town, America. Maybe it's because the pastures only LOOKED greener and they were actually happier here. Or maybe it's because we're fickle and when we say "never" we actually mean "never, unless I change my mind".

Hit the door running

I wonder sometimes why people come to work and then get ready to work. Shouldn't you be ready to work when you walk in the door? Granted, most days you actually have time to put your belongings in your locker and your lunch in the 'fridge. But haven't you ever walked in to a resident on the floor or someone being combative or whatever?

So I guess this is a post about appropriate dress at work. Having worked in an office for sixteen years, I can tell you that wearing a uniform every day is MUCH easier.

So, here we go:

• Wear your uniform. Don't wear a regular shirt and your scrub pants. Don't wear regular pants and your scrub shirt. In fact, I would say wear your uniform even on "Casual Day". Why would you want to get the Nursing Center (or wherever you work) all over your jeans and t-shirts that you wear at home or out with your friends?
• Wear appropriate footwear. These folks that insist on wearing these "Croc" things are just asking to get hurt. I've seen more people fall (including my husband, at home and at work) wearing these things. Yes, they're comfy. Yes, they come in pretty colors. Yes, you can get a pair for about ten dollars. But that trip to the ER is going to cost you a lot more when you land flat on your back and can't get up.
• If your hair is past your shoulders, put it up. Pony tails are OK, but I'm for a bun. If a resident is in a hair pulling mood, you won't find yourself on the end of a hair leash if you have your hair firmly secured. This goes for boys, too. We have a young man with long hair that puts his up. Work is not a fashion show. No one cares how you look. We only care how you work.
• Going back to uniforms, wear ones that fit properly. When you bend over, your fanny should not hang out. If you're a boy, I don't want to see your boxers and neither do the residents. See the bullet point above.
• Make sure you have showered and shaved and put on deodorant. No resident wants a greasy, hairy, smelly aide working with them. On the other hand, don't bother with the cologne. Your residents with COPD will thank you if you just smell like skin.

Did I miss anything? Do I sound like your mother? Or your grandma? Maybe that's the point. Dress like you care about what your momma would say. Someday you might be taking care of her.

More on staying healthy

So, since I've HAD to go see my doctor several times recently, she bullied me into getting a mammogram and a pap smear. So yesterday, that's what I did.

To all those women out there who have told me horror stories about their breasts being nearly torn asunder and their nipples almost popping off, allow me to now roll my eyes in your direction.

Jeez.

Either all of those women are serious wimps or they had the worst techs in the world handling them. I go through more pain with my migraines every month, and for longer periods of time, than I dealt with yesterday. If every medical test I ever had to have done was that easy, I'd probably go to the doctor more often.

OK. So that's a big, fat lie. But it's a nice thought.

Anyway. Go and get your mammogram done. It's not fun, but I promise, it's not as bad as everyone says it is.

Woo Hoo!

Sometimes things just work in your favor.

I've been wishing for three days off in a row for quite a while. The last time I had more than two days off in a row was in May when I took my vacation. I try not to ask for too many favors because:
A.) I don't like "owing" anyone anything.
B.) When I really want/need something, I want to be able to get it.

So, I've been trying to tough it out until December when (hopefully) I will be taking 4 days in a row off while my sister is here.

Well, I just had Sunday and Monday off. Today I get a phone call. They're making some last minute schedule changes and wanted to know if I wanted today off.

Yee Haw!!

Of course, I got all my chores done, so I have nothing to officially "do", but that's just fine. I think today will be a good day to bake some bread and coffee cake and whatever else I have the ingredients to make. I'd turn a cartwheel, but then I'd have to go back to the doctor and I've had about all I can take of her for a while.

Amazing what an extra eight hours of freedom does for your attitude.

On Staying Healthy...

...or not, as is the case with me.

So far in the last eight weeks, I've had two bladder infections, an infected tooth pulled and a head cold.

Go me.

So, where did I go wrong?

I have a bad, bad habit of ignoring my bladder. It tells me to go to the bathroom and I ignore it until, by the time I get there, it takes me a little bit to get going, as it were. That, in addition to not drinking enough water during the day has sent me to the doctor twice.

Stupid, I know. I have a hard time telling my residents and coworkers "no". Since I don't want to give the Doctor any more of my time and hard earned cash, I'll be hitting the head every two hours whether I think I have to go or not. I don't like water, but I'll be drinking at least three glasses on my shift.

The tooth is more about not having dental insurance until recently. Now I'm burning through my coverage before the year is out. No more visits until January.

The head cold? Probably being sick for six weeks made me more susceptible to the "Staff infection" going around work. We've even managed to share with some of the residents. I'm sure they'll be giving it back to us, mutated of course, so we can all enjoy it the second time around.

So, what do you think is the result of three rounds of antibiotics?

Yup, yeast infection.

Do as I say, not as I do.

Take care of yourself so you can take care of your residents. You're no good to them sick. Especially if you've got something they can catch.

A few funnies before I start the "week".

My weeks are four days on, two days off. Tomorrow is my Monday.

***

Mrs. A said to me "I think I'm over that disease now."

Knowing her diagnoses and knowing that nothing she has can be "gotten over", I asked, "What disease is that?"

She looked at me for a moment and said, "That disease where you get the book and read about it." (I assume she's talking about the booklets the doctors sometimes give you.)

***

"Where am I?" Mrs. B asked me.

Thinking she was confused, I said "You're at the Nursing Center."

She laughed. "I know. I just wanted to know if you knew where I was."

***

I lack a sense of where my body is in space. I would have made a terrible gymnast or ballerina. Thank goodness I'm too fat for either one of those professions.

Anyway, I tripped over Mrs. C's wheelchair.

"Ugh," I said, disgusted. "That was a nice trip."

"Kick it again!" Mrs. C said.

Returning to the chair, I asked, "Oh, once for you?" and booted the seat.

No Call No Show

We've had a rash of the old "No Call No Show" lately.

If you can't come to work, even if you aren't planning on coming back EVER, shouldn't you at least call to let us know? This mentality completely escapes me.

I can only think of three valid reasons for a "No Call No Show":

1. You have been stranded by a disaster, natural or otherwise, in an area with no cell phone coverage.
2. You are unconscious and no one in your family or network of friends knows where you are.
3. You are dead and no one in your family or network of friends knows it yet.

If you can think of any other good reasons, let me know. Maybe I'm just not seeing the whole picture or something.

Squeezing Out the Sponge

Currently, the gal that works first shift on my med cart and I have the same schedule. The other day she commented that on her first day, she's anxious and upset but by her fourth day, she's calm and ready to have a couple days off. I, on the other hand, come in calm on day one but by day four I'm frustrated and ready to explode.

I don't know how to classify her, but I am a sponge. After two days off, I'm squeezed out, clean and ready to go. By the fourth day at work, I'm full of dirt, half chewed food and nasty dishwater and unable to take on any more.

I'm not sure if this is good or not. What I need to do is figure out a way to speed up the turn around time, so I can squeeze out every day and come in each afternoon, ready to clean up.

I've tried all the healthy coping strategies and at least one unhealthy one. Nothing seems to work for more than a day or two. Maybe that's the key. Keep switching it up so that you don't become immune to any one treatment.

I don't have the answer, yet. I guess, like all of us, I'm day to day.

I figured it out.

I know why I like the mean, nasty residents.

Because I'm mean and nasty myself.

Prepare yourself before I tell this story because some of you are going to be offended.

Ready?

The other day shortly after I came on shift, my charge nurse came up to me and asked me to give Mrs. A some pain and anxiety medication.

"Wow, she must really be hurting." I said. This isn't unusual for this resident, but it doesn't happen every day.

"Yes and she's having behaviors. She peed on a Nurse Aide and told her she deserved it."

"Well, did she?" (I'm not sure if I'm proud or sad that this was my first question.)

The nurse made that disgusted sound you make when you can't believe what just came out of the other person's mouth.

"Who was it?" I asked.

"Jane Doe."

First I laughed and then I said. "Awesome. She does deserve it. In fact, we should let a few more residents pee on her."

Yup. I said it. The unfortunate truth is that I've gotten several complaints on this Aide. I've had residents request that she NEVER be allowed to work on their hall again. The sad thing is that she keeps being put on the same hall because she does the least damage there. So, the residents are stuck with her until the glorious day when she decides to quit.

So, now you know. And you young Nursing Assistants out there can start quaking in fear now of the day when I become your resident.

Attitude is Everything

The attitude you bring with you determines the outcome of your day. You can't control what happens, but you can control how you react to what happens.

Case in point: When a nurse comes up to me and ask "Did you take care of so and so today?" my first reaction is to cringe and ask what I did wrong. I freely admit that I often go with my first reaction instead of just smiling and saying "Yes." More than half the time, they are trying to pass on a resident or family compliment. Yet, I still think that every question that starts with "Did you...?" is going to end up with a reprimand. I think that we are conditioned to feel that crap rolls downhill and, as CNA's, we're at the bottom of the valley.

Do you think that for one day we could go to work with an open mind, a clear conscience, and a brave heart and see what happens? Could we do it for half a shift? Heck, maybe just the first two hours or the two hours during the shift when we feel we're at our best? And if we could, would it make us want to come in with this attitude all the time instead of the attitude of the already defeated warrior expecting more beatings the farther they travel?

It's worth a try. Sometimes we get the treatment that we act like we deserve even if we truly deserve much better.

Snippet of Conversation

I have a resident who doesn't speak very clearly. Most days I'm grateful when I can figure out what she's asking for once during a shift. However, this came out of her clear as a bell last night as I was trying to straighten up my cart before switching halls.

"And I don't give a shit, neither... Well... I do. Would it help?"

No idea. But it did crack me up.

Pain and the Weather

I always have to have a reason for everything. If my ladies are hurting, I want to figure out why. A lot of times I blame it on the weather, since the humidity and barometric pressure and all that seem to have an effect on our bodies.

For a couple of weeks during the summer, I looked at the Aches and Pains Index on www.weather.com to see if their chart coincided with my distribution of pain pills.

Nope.

They had the index at 3 or 4 (which is low) on all the days I felt like I was going to exhaust my supplies of Lortab.

That said, one of my ladies always starts hurting about two days out from bad weather. In the two years I've been giving her meds, she's the only one who's been completely consistent. Once the storm is breaking, she's doing really well.

My own experience is much like hers. If I'm going to get a migraine, it's more likely to happen when the weather is getting ready to change than during bad weather. Sunny, windy days about two days out from a storm will do me in almost every time.

In any case, I'm thinking that I can't be blaming the weather any more. Now, when they're hurting, I tell them, "Does it help to know you're not alone? Everyone's hurting or upset today." Usually the answer is "no". But it does give us something to talk about.

Pure Meanness

We have a Doctor that addresses one of his patients as "Meanness". As in, "Hello, Meanness, how are you today?"

I've said before that the meaner they are, the better I like them. Why I get so much joy out of the nasty things they say, I don't know, but I do.

Case in point: We have a family member that is very obviously going through her mid-life crisis. She's had her eyes "done" and has changed her make up and has dyed her hair. I don't work with her dad much as I usually have the other side of the nursing center, but she's there several times a week, so I know who she is.

The other day, Meanness was chatting with her about something and then looked her straight in the eye and asked, "Is that your real hair?"

Awesome.

Possessiveness

How many times have you heard this conversation or something like it?

"Mrs. A's family says blah, blah, blah."

"Pfft. What do they know? They never come to see her anyway."

I think sometimes we get possessive of our residents. We spend forty or more hours a week with them, so we think that we are closer to them than their families are. In some cases, this might be true, but I think that for the most part, the resident's families really care about them and do know more about them than we do. Whether they have time to come and see their mom or dad in the nursing home is another story.

On the other side of the coin, I think the families sometimes are in denial about the person their loved one has become. Living in a nursing home requires a whole new set of coping mechanisms and developing them tends to change people. The changes are not necessarily for the better. Folks don't want to think of their mom or dad becoming cantankerous when they used to be kind or reclusive when they used to be outgoing, but it happens. Sometimes they are very shocked and upset with us when they do see the changes. And then we get bent out of shape when they comment on what they see.

Communication is key. If the family cannot come to see the resident, keeping them apprised of the resident's condition is more important than ever. I'm not sure that my facility does a very good job of this. I wonder if there are any out there that do.

Funny Stuff

So, I was going through some old writing stuff the other day and I found a sheet of paper where I had written some resident quotes down that had cracked me up.

***

"Mrs. A! you have to open your eyes so I can put your eye drops in!" (Mrs. A is stone deaf and doesn't wear her hearing aids, so I have to yell in her ear.)

"Well," she said, "I thought, 'these aren't working very well'."

***

"I'll take these pills and they'll take away my aches and pains so I can go to sleep," Mrs. B said, holding up the Tylenol I had just given her.

"I'll take some pills and they'll take away my aches and pains so I can get some more aches and pains," said her roommate, Mrs. C.

***

As I was trying to get Mrs. D to wake up enough to let me take her blood pressure, Mrs. E asked "So, do you like working with people like her or is it easier when they have a little life in them?"

It's that time of year again

So, let's talk about how to stay healthy when everyone around you is getting sick.

**Wash your hands. I know this is a no-brainer, but the more you wash your hands, the less times you'll get sick this cold and flu season. I prefer alcohol gel, myself. I guess in Oklahoma they want you to wash your hands after every six times you use alcohol gel. Right. My rule is that if I have to go into the dirty linen room, I wash my hands. If not, it's gel all the way. Some nights, the highest I can count is three. (As in: "Alright. We're going to stand up now. One, two, three!")

**Don't touch your face. Hard, hard, hard to do. But if you get a pathogen on your hands, you're less likely to get sick if you don't transfer it to your eyes, nose or mouth.

**If your facility offers flu shots, take them unless there's a reason you can't do so.

**If you're vomiting, have diarrhea or a temperature over 100, stay home so you don't share your happiness with everyone in the facility. If you have a runny nose, sore throat and feel generally crappy, GO TO WORK. Your residents need you and you were contagious twenty-four hours before you even felt sick, so you've already shared your fun. Might as well go in and enjoy it with everyone else.

**Get enough rest. Also hard to do. During sleep is when you heal and your body can fight off any little thing that might be trying to become a big thing.

**Stay away from the sugar and get a little exercise. Sugar can suppress your immune system, besides making you fat and cranky when you come off that sugar high. Anyone who tells you they get enough exercise at work is full of beans... or something. Exercise improves your mood and can boost your immune system. Which will be helpful in case you can't avoid that Milky Way bar in the vending machine that keeps calling your name.

That's my plan. I guess I'll let you know how it works for me this year. Last year it seemed like I caught every bug that came my way, but I wasn't doing the healthy eating/exercise thing. This year I'm going to try it and see where it gets me.

That's how I want to go.

One of my ladies lost a friend this week. She showed me the memorial from the woman's funeral.

The lady was 95 years old. She had lost her only child when it was a baby and her husband passed away in 1970-something.

Since then she has worked and also been an active member in her church and the community.

One of the things she liked to do was play piano. She would volunteer to play for the "old folks at the nursing home" as she liked to call them.

She was seated at the piano and had raised her hands to play when she passed away.

Traumatic for the people around her, but what a gift for her.

I hope when my time comes, I'm doing something I love to do so my last memory will be a good one.

Sometimes I forget...

...to keep my opinions to myself.

Politics is not something I usually discuss. At all. My knowledge of what is going on in the world is pretty much limited to whatever is blaring over the screens on my resident's televisions and whatever headlines I see on the 'net when I don't get where I want to go fast enough.

Frankly, I'm happy this way.

But the hullabaloo over the Mosque at Ground Zero isn't something I could miss. Everyone from Fox News to Trinity Broadcasting Network had something to say about it.

Personally, I don't care. They can worship wherever they want to as long as they're not hurting themselves or anyone else while doing it.

I made the mistake of saying this in front of a resident's family. A bunch of opinionated Baptists at that, who only watch Fox News and Trinity Broadcasting Network.

Whoops. Won't do that again. I got an earful.

I backpedaled out of it saying I didn't really know what's going on because I didn't watch the news.

Whatever. I still don't care. My primary objective is to take care of their family member to the best of my ability. Nothing else really matters. As long as Mrs. A is comfortable, clean and as healthy as she can be, the rest is just dust in the wind.

Still, I'll be chewing the life out of my tongue the next time something incendiary makes its way to every television station on the planet.

Alzheimer's Patient's Bill of Rights

I found this today on Nursing Assistants dot net (I have a link to them under my "Good Stuff" column.)

Alzheimer's Disease Bill of Rights

• To be informed of one's diagnosis.
• To have appropriate, ongoing medical care.
• To be productive in work and play as long as possible.
• To be treated like an adult, not a child.
• To have expressed feelings taken seriously.
• To be free from psychotropic medications if at all possible.
• To live in a safe, structured, and predictable environment.
• To enjoy meaningful activities to fill each day.
• To be out of doors on a regular basis.
• To have physical contact, including hugging, caressing, and hand holding.
• To be with persons who know one's life story, including cultural and religious traditions.
• To be cared for by persons well trained in dementia care.

Source: "The Best Friends Approach to Alzheimer's Care", Virginia Bell and David Troxel, Health Profession Press, 1997 http://bestfriendsapproach.com/index.php

I'll be looking for this book at my library. If I really like it, I'll buy myself a copy.

New Acronym: DN

We have a few hot headed residents right now. Some are long term care, some are just in for physical therapy so we can get them on their feet and back to their regularly scheduled lives. In any event, we now have a new acronym: DN. That's "Damn Nurse" to you. As in, "I want to see the Damn Nurse". I'm not sure where that falls in the hierarchy of LPN and RN, but it's definitely in there somewhere.

I think it's kind of like a choice between being the windshield or the bug. Sometimes you get to be the Nurse, sometimes you get to be the Damn Nurse. Sometimes neither one is a good choice.

RSD

So, aside from the high I get from making the Ladies and Gents happy (I was told that I give one man a "warm fuzzy feeling" just by being in the building) the other thing I love about this job is that I get to learn new stuff every day.

When Mr. A told me he had RSD, I thought it was something he had made up. (He calls his Dilaudid "Bin Laden". Which may be an apt name, for all I know.) When I looked it up online, however, I found out that it is a real thing. And it's a doozy.

Here's a link to the website: http://www.rsds.org/index2.html

Symptoms are:

• Severe burning pain
• Pathological changes in bone and skin
• Excessive sweating
• Tissue swelling
• Extreme sensitivity to touch

Here are three more things from the website that I found interesting:

• It is a chronic pain syndrome characterized by severe and relentless pain that affects between 200,000 and 1.2 million Americans. (To me this means there are a LOT of undiagnosed cases out there.)
• This is not a psychological syndrome, but people may develop psychological problems when physicians, family, friends and coworkers do not believe their complaints of pain. (If everyone tells me I'm crazy, then I must really be crazy, right?)
• Minor injuries, such as a sprain or fall are frequent causes. One characteristic of the disease is that the pain is much worse than expected for the type of injury that occurred. (When we have our "Pain Management" inservice, we always talk about how "pain is what the resident says it is". Yet I often hear "I just gave them a Lortab 10 an hour ago. They can't be hurting.")

Just because we haven't heard of it, doesn't mean it doesn't exist. Just because the resident is confused about some things, doesn't mean the resident is confused about everything. I'm glad I took the time to look it up. It makes me more effective when working with Mr. A and makes him more comfortable when I'm on shift.

I'm a "Fixer"

This is what I do. I fix things. If you're sick, hurt, scared, have to pee, I can fix it or find someone who can. I have a pill, a tactic, a technique or a minute to listen to you so you will be better off than you were when I first walked into the room.

So yesterday when I went to Sherman's funeral what did I have to fix it?

Not a darn thing.

There isn't a pill, tactic or technique that's going to make this grief go away. I even said to Vickie, "I would fix this if I could". And I can't. I'm helpless and I'm not happy about it.

All the hugs and sympathetic ears in the world aren't going to make this better any faster. And the more involved you were in his life, the longer it is going to take to get over it.

Oh, and for the record, funerals are supposed to give you a sense of closure. It didn't work for me. When I saw him lying there, it was like it wasn't him but a statue someone had carved and painted to look like him. His soul was missing and you could feel it's absence like it was a hole in the atmosphere.

I guess I should be glad I work in an environment that lends itself to my desire to fix things and allows me to be reasonably successful at it. If I had to walk around feeling helpless all the time, I'd probably lose my mind.

In Memoriam

One of my co-workers passed away yesterday.

Sherman had been a CNA for well over ten years when I first came to work. He and Vickie were responsible for most of my training. I wouldn't say he took me under his wing, but since I could keep up with him, I was able to learn a lot.

He taught me that the resident is the boss. He taught me that it was ok to be upset, but never to let a resident see it. He taught me that you need to sneak your breaks in when you can because you don't know if the night will allow you to get another one before the end of your shift.

Sherman could be a jerk. If his perception was that you were lazy or stupid, he'd work around you until you got the message and quit. He was responsible for "running off" his share of inferior nursing assistants.

That said, he never turned down a request for help. He was good to his residents. The highest compliment a resident could pay to another male CNA was "he's almost as good as Sherman".

Knowing you're in a better place isn't much comfort to me. I won't get to hear your stories or benefit from your experience any more. I won't get to laugh when you say something so off color that it makes everyone around you blush. I won't get to join in your frustration when things aren't going well or your joy when something actually goes right. I miss you already, Sherman. Rest in peace, man.

The Roxanol Question

Yes, it's a two post day.

I accept the fact that the longer I am in the nursing center, the more people I take care of will pass away.

I accept the fact that my residents who are under hospice care are not going to get better and that their last few days may be fraught with pain and anxiety.

I accept the fact that medicating my residents to the full extent allowed by their doctor is part of the deal and that it may hasten the end for them.

So tell me why I have nurses who will not authorize the use of Roxanol to ease my dying resident's pain and anxiety?

The doctor's aren't stupid. They know what Roxanol is. They know that while it eases the resident's pain, it also slows down the breathing and heart rate and that this may push the resident over the edge into death. They know all this and yet they have still prescribed it.

Ya know why? Because the resident's condition warrants it.

Still the charge nurses don't want to authorize its use. The resident is in pain. We have this drug that will work almost immediately to ease the pain. But let's not use it. Let's use something else that takes longer and doesn't work as well because we don't want to be the one who authorized their last dose of anything, ever.

Not me. I say give it to them. By the time the doctor gives us a prescription for this stuff, the resident only has days to live. (Actually, I had one resident who used it long term, but that's been one out of well over one hundred residents that I've worked with.) Let's keep them comfortable. Reducing their suffering also reduces the family's suffering and anxiety. And if their life is shortened by a few hours or days, so be it. They weren't going to be up and dancing jigs in the hall anyway.

For me it never has been a question. Keep the resident comfortable by every means we have available. Anything else is unconscionable as far as I'm concerned.

Losing my sense of humor

Sometimes the stress level in the nursing center skyrockets. Yes, it's always high, but every so often we seem to go right off the top of the current charts.

We're there now.

No one seems to know why. It's not a full moon. The weather has been pretty good down here. The "pain index" according to weather.com has been a 3 or 4, which is low. We have a pretty good group of employees right now. At least they all seem to be coming in to work regularly and that had been a problem recently.

I don't know what the deal is, but everyone is losing their sense of humor.

For a long time, I would try to write down the funny things that my residents said, because someone says something funny every single day. I've forgotten to do that lately. I'm going to start up again. Sometimes that one laugh we get is all that gets us through the shift.

So, here's one from the other day:

Mrs. A has been one of our more animated residents lately. She has been yelling and talking a mile a minute for several days now. And loud. You can hear her clear to the ends of the hallways.

One of the Med Aides was outside her door trying to pull her pills. She kept yelling and trying to get them to come into her room. The Med Aide kept telling the resident they were going to be in with her in a moment, but she just kept going.

Finally, she tried another tactic. "Here, doggy, doggy, doggy." And then she started laughing. Actually, we all started laughing. Funny how the atmosphere changed immediately.

I really need to find my sense of humor again.

Sometimes I wonder...

...what on earth has happened on the previous shift, based on my resident's comments.

I had a resident tell me yesterday that they needed to talk to one of my cohorts from the morning crew and could I let them know.

I explained that I wouldn't see them before then, but that I would leave them a note.

The resident then proceeded to say how they wanted to apologize because they had made it hard on the CNA and they felt bad.

My response was along the lines of, "You can apologize if you want to, but you don't have to. We understand that this is a rough time in your life. We just want to get you well and get you out of this joint." (Yes, I often refer to the Nursing Center as "this joint". I know it's a prison reference. I was just trying to insert a little levity into a serious and painful conversation.)

Obviously, the resident got a negative vibe from that CNA, whether any words were exchanged or not.

I don't understand how we can profess to be "there for the residents" and then still manage to make them feel bad when they take up our time.

In any event, I think the resident felt better after that. I hope so, anyway.

Separate note: Inservice is today. Pray for me.

An Embarrassment of Riches

We actually had 7 CNA's scheduled last night. Granted, one was an orientee, but she was just new to the facility, not a new CNA.

I didn't know how to act.

I was still busy, but for a change I didn't feel overwhelmed. I was still smiling when I clocked out for the night. This doesn't happen very often anymore.

I know that the DON and ADON feel like they've exhausted their options for hiring. We live in Small Town, America and it's hard to even find enough people to work much less finding good ones. And out here, people don't want to drive to the next hamlet to work. They want to work close to home. But nights like last night are so great I wish we could hire ten more and just keep them around in case we need them.

Well, I enjoyed it anyway. As we know, tonight may be an embarrassment of a different kind.

What they want the most...

...is for someone to stop and listen to them.

Unfortunately, when we're doing the "Short-handed Shuffle", the thing we have the least of is time. Also, unfortunately, this is the time when they need our time the most. They feel neglected when we're running around like decapitated chickens.

My advice? Do one thing at a time.

I think a lot of times we fall into the trap of trying to turn off all the call lights in order to stop the beeping (and keep the Charge Nurse off our butts) and then go back to do what we've been asked. My experience has been that all this accomplishes is us forgetting one or more of the requests and then we have upset residents. We're better off if we take care of one resident and then go on to the next one. Yes, it will look like we always have a call light on, but if our charge nurse is paying attention, she'll see that it's a different one and that we are getting things done.

Also, before we leave the room, we should try to remember to ask if there's anything else they need. And wait for the full answer. Sometimes they will start out with "no" followed by "but". An extra two minutes spent here will prevent us from running back to that room two or three times more.

One last thought. While it's nice to get away from the residents and take a break with the other nursing staff, try taking a break in a resident's room once in a while. Especially with some of the ones who don't get a lot of visitors. I don't do this as often as I should. Whenever I do, I always feel good about myself and my job. As opposed to when I go on breaks with my compatriots where we complain about everything from management to each other. A little kindness spreads a lot of joy.

Lost my temper...

...with a resident. Ugh.

I'll bet I couldn't even fill one hand with the times I've lost my temper with a resident. With my co-workers, it's at least once every three or four days, but not with my residents.

All I did was raise my voice. I didn't swear, call her names, or anything awful. When all was said and done, she thanked me for taking care of her, but here I am, days later, still feeling like a big jerk.

I've treated members of my family worse with little or no remorse afterward.

I know when I go back to work tomorrow, she won't even remember me, much less the incident, but it doesn't really make me feel better.

I did confess to my charge nurse. At least if it comes up, I can say I told on myself.

Looking back, I should have just walked away, let her do what she was going to do and then cleaned up the mess afterward. That was what ended up happening anyway and I could be sitting here guilt-free instead of beating myself up.

Add this to the "live and learn" file.

"Nurses eat their young..."

"...I don't know why, but we are terribly mean to each other."

Words of wisdom from my DON.

I'm pretty patient and easy to get along with. (Yes, AT WORK. At home I'm a different creature altogether.) If I am "mean" to you at work, likely it's because you aren't working. And I am willing to pull a lot of your weight before I start to lose my sense of humor. After that, not only am I going to tell you I feel overwhelmed, I'm going to tell my Charge Nurse that you are worthless and I don't want to work with you any more. So, then she's going to start riding your butt and you're going to go home and cry to your family that we're "mean".

I have never had a Charge Nurse be "mean" to me. But I'm a hard worker and I'm nice to my residents. If your residents like you, most of the time your Charge Nurse will, too. Unless she's a complete and utter cow and those are few and far between.

Nurses may eat their young, but maybe its just natural selection at work.

Shift work

I love working second shift. I always have, even when I worked in an office. There's something about having the morning to do what I want that makes me happy. Also, when you're at work, it has the most natural rhythm. It's busy when you come in to work, but then slows down as the night goes on.

First shift is rough because you are running two-forty the entire shift. Get them up, feed them, activities or nap time then do the whole thing all over again. The least little delay throws your entire schedule off.

Third shift is the hardest of the three. It starts out slow, but then, just when you're really getting tired, you have to start running to get people up for the day. No wonder they have to offer a shift differential to get folks to work that shift.

Everything else being equal, I'll take second shift every time.

Lack of choices.

Being in rural Oklahoma means you have a limited pool of people to choose from whether you are talking about residents or staff. While we have gotten more residents and more staff, we still need more residents and we need some staff that actually are willing to stay on and work.

We had a CNA walk out on us. So, of course, since it happened on my shift, not only did I have to help cover until one of the CNA's from the next shift came in early, but I also had to attend a pow-wow with the DON because the CNA said she left because the staff was rude to her.

Please.

If I walked out on a job every time someone was rude to me, I'd never work anywhere more than one day. People are rude. That's all there is to it. Doesn't matter if it's a resident, coworker, or a family member. One of our other staff members told the DON that "rude" is just an excuse they use because they don't want to work.

Can I hear an "amen"?

Regardless, we now need another CNA. One who will work and not get offended if we aren't mollycoddling them.

Same Stuff Different Day

Yesterday was my first day back from vacation. (And moving and visiting with my sister and brother in law.)

It was pretty much the same as when I left.

We had a couple new faces. Which is good. Higher census means more money and more staff and the other good things that go along with more money.

No one passed away. Also good. I hate coming back from days off and finding out Mr. So and So died.

Staff drama hasn't changed. The shift wars and department wars are alive and well. People who should be working as a team can't get along. You know, the usual.

It would have been nice if all the things I didn't like had changed for my benefit while I was gone, but no such luck. Nothing really awful happened either, so I guess I can't complain.

I have noticed, however, that my coworkers are already trying to see if they can set my hair on fire. I guess they want to know how long the vacation afterglow is going to last. I think I'm going to see how long I can keep from getting involved in their dramas. That would be some different stuff for a different day.

Finally, back online.

Jeez. Sorry for the ridiculous delay. I'm back online. Permanently, as long as I pay the cable bill. :) Give me a couple days. I've been on vacation from work, but we've moved residences and I'm up to my ears in stress.

Here's a funny conversation I had before going on vacation.

Mrs. A is a bossy lady. She's ex-military and she used to work in a Nursing Center. Nothing gets by her. She's also mean as snot and that means she's one of my favorites.

Mrs. A: Well, your hair is just in a little ball on the back of your head. It must not be any longer than your shoulders.

Me: Actually, it's pretty long. It's just fine and I don't have a lot of it. Next time I come to work with it down, I'll come and show you. (For the record, this only happens when inservice day falls on my day off.)

Mrs. A: If you come to work with your hair down, I'll send you home.

Guess she told me. :)

Appropriate Responses

Had an incident yesterday where a CNA that I work with found it necessary to confront a resident who had complained about her.

Really? Someone explain to me why this is a good idea.

There's only two proper responses to a resident complaint: Silence or an apology. Confronting a resident is never a good idea.

Luckily for the CNA, the resident didn't want anything further done. Technically, this would be abuse and the CNA could have come under investigation.

Some days I wonder if people unplug their frontal lobes before coming to work. Grr.

Future Entertainment

So, yesterday we had a gentleman come in and sing Karaoke for the residents. Mostly old country tunes and spiritual songs.

When it's my turn, do you think someone will come out and perform "Succubus" by Five Finger Death Punch for my listening pleasure?

Previous Occupation

Warning: Sexist material to follow.

One of the many pieces of information that we have on our residents is what they did to make a living. The ones I find the most interesting are the women who worked outside the home. Most of my ladies are between 75 and 95 years old. They were CNA's, LPN's, School Teachers, Shop Keepers, Waitresses, Farmers, Bar owners (yes, we have a couple of those) and Domestic Technicians. All of them had children. Somehow, they managed to work, keep house, raise children and keep a man happy (at least for a little while). Some of them worked away from home when it was looked down upon. (As if contributing finacially to the family were shameful.) Keep in mind, too, that this is "The South" and we're a good 10 to 15 years behind the times as far as acceptance of women as equals.

Sometimes when I'm talking to them, I get a glimpse of that steel that kept them going even when they were bone tired from work and still had children to bathe and dishes to wash. It's no wonder they've outlived their husbands and, in some cases, their children. They've been going so long, they don't quite know how to stop.

So, what's the point? When we think work is rough, try to see it from their perspective. They watch us work and they've already been there, done that and sewn their own t-shirts. They got through it and they expect the same from us. Frankly, they don't want to hear our complaints, they just want us to take care of them the way they took care of their customers back in the day. (Well, maybe not the bar owner who used to chase unruly patrons out with a broom, but the rest of them.)

It's the least we can do.

The Good with the Bad

If you need an active illustration of how you need to take the good with the bad, work in a Nursing Center. Every day I run the gamut from being so frustrated, I could cry, to being so happy I can't help but smile. Sometimes in the same five minutes with the same resident.

***
Mrs. A talks in a word salad. Sometimes from her tone, you can understand what she means. Sometimes, not so much. Once in a while she can really express herself.

One day she was chattering at me and getting angry and starting to cuss me out.

"Mrs. A," I said "Look at these copies I just made. There's a big blank strip right in the middle." I showed them to her.

She looked at me and tapped her temple with her index finger. "Kind of like up here," she said.

***
Mrs. B was having a really rough day. She told me she'd be happier if she was six feet under. I spent a little time with her and let her talk, mostly just asking her questions about what she was telling me and not trying to comfort her, exactly. Eventually, she started talking about a friend of hers who had the same name as me and by the time I left she seemed lighter hearted, although she was still a little miffed that I had to leave.

The next day her roommate, Mrs. C commented on how it was good of me to talk to Mrs. B and that sometimes listening was better than a pill.

***
Mrs. D has been uninterested in her meals for a while. She's lost a little weight and we're all worried about her. We're all encouraging her to eat or drink every chance we get. The one day, she held her tray out to me and said, "Do you want this?" When I said "no", she replied, "Well maybe you can find someone else to eat it because I'm not going to."

***
Mrs. E balks every time I give her medication. She takes it, but only after a little conversation first. One day it went like this:
"Take all these pills?"
"Yes. then that's all for today."
"Gonna swell my stomach," she groused. "Make me look like I'm pregnant."

***
Mrs. F is another word salad speaker. Honestly, I can almost never understand what she's saying, but I talk to her like I can anyway.

She had gotten a haircut and it was almost too short.

"I wish they wouldn't cut your hair so short. You have such nice hair," I said.

"That's when you get teased," she said and laughed.

***
I was counting the number of residents who have passed away since I started work on February 27, 2008. It's in excess of 40. But when I think of what I learned from each of them and about the times we laughed together, I laugh out loud.

I am very, very lucky to have stumbled into this line of work.

All Apologies

Sorry for the hiatus.

We've had twice the snow of a normal Oklahoma winter. We've been here for 8 winters and this is only the second time I've seen snow on the ground last longer than a week. I've had four colds and one go 'round with the stomach flu (which made me miss my first day of work since Feb. 27, 2008).

I'll be more regular again for a while. I plan on coming over and making the boys cookies in trade for internet time. And I'm working on a couple real posts to put up.

Side note: please say a prayer for my sister-in-law, Allie, who is having surgery on Tuesday.

Back on track next week.

Nursing Addictions

Kind of a downer subject to start the new year with, but several things have happened that have brought the subject front and center.

A nurse and a CNA I know had to check themselves into rehab to avoid a trip to jail. I've had several complaints lately that involved CNA's taking smoke breaks at inappropriate times. And another CNA confessed her meth addiction to me and then asked me not to "think less" of her.

Jeez.

I am lucky that I don't have an addictive personality. But why does it seem so prevalent in our profession? Is it that we give so much of ourselves to our residents that we need to replace what we've lost with a chemical?

I jokingly suggested to my meth infused co-worker that she take up running. She could use a positive outlet for her negative emotions. She laughed at me and said it's time for her to "grow up" and that the last time she ran was in eighth grade. She'll just start drinking again instead.

Jeez, again.

I have been told by more than one source that if they drug tested our facility there would be about five employees left. Three, if it's a weekend and they were testing for alcohol, too. All of the aforementioned people are reasonably good employees and care about their residents.

Maybe there's no solution. Maybe we really do need to replace what we give with something else. Me, I'm taking up running this year. Maybe next year I'll be able to run a couple races. Maybe in two years I'll run a half marathon.

I'll let you know if I get addicted.