Merry Christmas Everyone!

Hope you have a safe, blessed and happy Christmas and New Year.

See you next year!

Dirty Old Women

We only have a couple male nurses on staff.  One of them worked last night.

I walked into Mrs. A's room.  She wasn't there, but her walker was.  I knocked on the bathroom door.

"Yes?"

"Mrs. A, are your legs still bothering you?"

"Yes."

"Do you need a pain pill?"

"Yes.  And some of that stuff you rub on my legs."

"OK.  The nurse has that.  Let me go tell him."

So, I located the nurse, told him what she needed and returned to the room.

When I arrived, she was sitting on the side of the bed in her nightgown.  As I was watching her take her pills, Mr. Nurse knocked on the door.

Mrs. A looked up and her eyebrows shot up on her forehead.

"Come in.  We're dressed appropriately," she said in her best coquette voice.

I just started laughing.  And she did, too.

"Heh heh heh.  I'll bet he's half my age," she said to me.

Which made me laugh harder.

"Do I even want to know what you're talking about?" Mr. Nurse asked.

"Just you," I said and left him to his fate.

First Cold of the Season

Well, I finally caught it.  Everyone around me has been sick at least once since September, some two or three times.  Now, I'm sick.

No fever, so I'll be going to work.  We don't get sick pay and it's Sunday.  Even if I could afford it, there isn't anyone who will cover for me on a Sunday.

I still have my tonsils, so it's resting in my throat.  I'm trying to avoid taking any cold medicine, so I'm treating myself with lots of tea during the day.  At night before I go to bed, it's a shot of Jack and a spoonful of honey.  I don't know if it's helping, but I'm not all fuzzy headed like I would be if I were taking OTC cold meds.  I'd rather feel sick than like my head is floating somewhere three feet away from my body.

I've got four days off in a row coming up this week.  I can tough it out for three more days.  If my coworker who got in a car accident is released to come back to work, I might even have six in a row.  That, I fear, is a pipe dream, but we'll see.

Do you ever wonder...

...if we might only exist to be lab rats for the pharmaceutical companies?

This is a little off topic, but not much.  In the last year I have had several residents who have come in with only two or three prescriptions, who now have over 9.  Not because they have necessarily had anything really wrong, but because the pharmacy consultants give the doctors recommendations and they take them.

For example, Resident A can no longer take care of themselves at home.  They come in with a blood pressure medication and a multi-vitamin.  Then, the pharmacy consultants come in.  Now they need vitamin D once a week.  Oh, and they are at risk for osteoporosis, so lets give them calcium.  Then the blood tests start. So, their triglycerides are high. Let's poke four fish oil pills down them a day.  Now they're getting confused, so let's put them on a memory pill.  Well, now their appetite is not good and they're losing weight.  Of course, we can't stop the memory pill, because they're confused, so lets put them on an appetite stimulant.  A couple months later we do another blood test and now their sugar is high, so we treat that.

And on, and on, and on.

I'm not against folks being as healthy as they can be.  I am against taking medication just because a study shows that it might be good for me.  That includes vitamins.  Further, I'm against taking medication to counteract the side effect of another medication.  I'm pretty sure a memory pill never saved anyone's life.  If the memory pill is ruining your appetite, how about just discontinuing the memory pill?

I have heard that you shouldn't be on more than nine different medications as a general rule.  Nine.  I have resident's who are on over twenty.  Yes, over 20, including all the vitamins.  Someone's benefiting from this.  I'm not sure that it's the resident.

Can you repeat that?

"Can you call my daughter for me?" Mrs. A asked the nurse.

"Sure," she said, picking up the receiver.

"Her number is 30301."

"I'm sorry," said the nurse.  "I didn't catch all of it.  What was it again?"

"30301.  I can't remember the other two numbers."

(I love how they think we can just pull this information out of our pants.  We "grow up", then we "grow down".)

Control

We spend the first 15 or 20 years of our life trying to get control of it.  You find me someone on the planet who hasn't started a sentence with "When I grow up I'm not going to..."

After that, hopefully, we get things running in our general preference of direction.  It's not perfect, but at least our mistakes are our own.

When we get to the end, the people around us start to take over again and we're stuck back where we were.  They decide what we eat, and when.  What medication we take, and when.  What clothing we wear, what time we get up and go to bed and a thousand other things that we have managed to control for 40, 50, or 60 years.

Is it any wonder the residents get mad at us?  We're just doing our best to make sure everyone gets taken care of, but they see it as us stealing their independence.

I got accused of treating a resident like an animal yesterday.  If you think about it, they're right.  We do the same thing to our pets and farm animals.  When you put people in a group setting, it becomes harder to treat them like individuals.  Especially when your nursing center is still operating under the old mindset of  "Breakfast is at 7:30, Lunch at 11:30, Supper at 5:00 and everyone needs to be in bed by 10:00".

Every once in a while I hear mumbling about culture change.  I'm looking forward to it.  Giving the residents a little control back will make things more chaotic, but it will also make them happier about being in a less than ideal situation.

Some Things are More Important...

"Mrs. A was unresponsive this morning.  We sent her out.  I think they're sending her back."

This is what I was told as soon as I came on shift yesterday.

A little later, the nurse came and gave me the paperwork and told me she was coming back.  I figured she was going to be sick and worn out, so I got her bed ready and laid out her night gown so we could get her back to bed.

I got busy passing ice and snacks and when I looked at my watch, an hour and a half had passed.  I started heading for the nurse's station, thinking that maybe something had happened and they decided to keep her.  As I'm walking down the hall, here comes Mrs. A, peddling herself back up the hall with an armload of trinkets.

"Hi Honey!" she called to me.  "I won three times at Bingo!"

The Angel Tree

Our nursing center does an Angel Tree at Christmas.  All the employees pick a resident's name and bring them a gift so that they have at least one thing to open at the Christmas Party.

Last year I picked two.  Neither one really got to use my gifts because they both passed away within a month or so of Christmas.

So, to minimize the damage, I only picked one name this year.  Thankfully, it's a resident I know.  Unfortunately, I have no idea what to get them.  They are bed-bound.  They don't read.  They are not really capable of watching television because they can't follow it or they think that it's real.  (I spent a couple hours one afternoon trying to convince them that the house fire on the TV was not actually happening in the building.)  They are at the point where they often eat with their fingers because it's "easier".  They are in that awful Limbo between not really being able to live, but being too strong to die.

I think I'm going to have to go the route of bath products.  At least I know they'll get used.  It seems like a lame gift.  Maybe when I get to the store something will inspire me.

Stuff Seniors Say

Sometimes you just want to know that you're not alone.

"Are you busy?" Mrs. A wanted to know.

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

"Nothing.  I just wanted to know if you were busy or if you were pretending to be busy."

"I'm not sure," I said, because I had no idea how to answer that.

"Well, good.  I thought I was the only one who didn't know what was going on."

***

Proof that we never really outgrow adolescence. 

"I can't roll all over this place just to catch you," Mr. B said to Mrs. C.

(Yes, Mrs. C.  There's a Mr. C and they both stay at the nursing center.)

"Well, you better quit because you're not gonna get me."

O/T: You're in trouble now

One of the girls I work with recently lost her father-in-law.  Her mother-in-law watches her kids (she has a half of a baseball team's worth).  Once the funeral was over and life settled down a little, the kids went back to Grandma's, as usual.

"Grandma, will you take me to heaven?" one of the boys asked.

After some conversation, she figured out that he was asking to go to the cemetery.

So, she gathered everyone up, loaded them in the van and off they went.  Once they arrived, they piled out and the one who had requested the trip marched right over to the grave.

"Grandpa, Grandma has not made me soup yet."

Busted.

Happy Thanksgiving

I actually have the day off, but I'm working Friday.  I'll be home long enough to mess up the kitchen, but good, and then back to work for a day before having Saturday off.

Enjoy your Turkey Day!

Body Language

Yesterday I was standing and talking to my husband with my hands on my hips.  It wasn't a hands on hips type of conversation, that was just how I was standing.

"Don't stand like that.  It makes you look aggressive."

Funny, but I think about this at work all the time.  For some reason, arms akimbo is my default.  I catch myself standing that way constantly.  My first reaction is to put my hands behind my back when I notice it.

The other day Mrs. A asked me if I stood with my hands folded behind my back to keep myself out of trouble.

"That's exactly right," I told her.

Residents notice.  Even if they aren't able to get the words out, they can tell how you are feeling by the way you stand when you're working with them.  Arms akimbo can make them feel like you are being bossy or are in a hurry.  Arms crossed is defensive and makes them feel like you aren't listening or you don't care.  Keeping your arms relaxed at your sides when talking to them shows that you're listening and are willing to do what it takes to help them.  If they feel comfortable, they are less likely to get upset or angry and that automatically makes the day go smoother.

Dating Coworkers

I'm absolutely against coworkers dating.  And, yes, I am a hypocrite because I have worked at several jobs with my husband over the years.  I'm still against it.

This is coming up because we have a boomerang CNA who likes to date coworkers.  Who likes to live with coworkers.  And then, when the break up happens, it rocks the nursing center.  People quit, people take sides, people try to run other people off.  It's stupid, disruptive, and frustrating.  Can you imagine what the resident's think?

I could tell you, but you'd be surprised at how raunchy our elders can be.  Let's just say that whatever you just thought about it, they've already thought a hundred times before.  And their executive function is not what it used to be, so some of them just say it.  Loud.  Because they can't hear.  But a lot of other folks can.

If you simply must date a coworker, you should conduct your relationship so no one else you work with knows about it.  I worked with a couple for nearly a year before I knew they were a couple.  Even after I knew, they didn't do anything at work that indicated they were living together.  They kept their work and their home lives separate.  As it should be.

Regardless of that one good example, I've seen, oh, probably five couples break up since I started working as a CNA.  It's not good for anyone.  It hurts the residents, the rest of the staff, and the business itself.  Better to avoid it altogether.  It's a big world out there.  Find someone else to date.

Thoughts

• Resident's with dementia are like the weather in Chicago.  If you don't like it, wait a minute, it'll change.
• One eight hour shift working the floor nets me about 14000 steps according to my pedometer.  Conversely, giving 25 people meds for one shift gets me about 5000 steps, 35 people, 7500.
• The only right answer to "Are you busy?" is "What can I do for you?"
• Raising children is good training for being a CNA.  The goals are the same.  Keep them warm, clean, dry, fed, and don't let them knock the snot out of each other.

"Selling Buicks" and Other Not So Fun Body Functions

So, we've got some kind of stomach bug making it's way around work, staff and residents included.  It's just a twenty-four hour thing, but I've been "better" for five days now and I still have waves of nausea now and then.

For the record, I worked through it.  Amazing what enough Dramamine and Immodium will do for you.  Probably why I'm still not over it.  But, everyone got taken care of Sunday and the rest of my week and no one had to cover for me.

I realize I am opening up the "working sick" can of worms again.  If we had enough help, I probably would have stayed home.  Without me there, the facility wouldn't have had the legally required amount of staff.  And, I promise you, NO ONE will cover for you on a Sunday.  So, there's probably someone who is sick just because I carried that pathogen into their room, but the rest of the facility is better off because I was there.

Rock.  Hard place.  I chose the rock.

Got Mentioned in a Post

20 Useful Online Tutorials for Nursing Assistants

Nursing Assistant Guides mentioned this blog in the above post.  I don't have time to read more today, but it looks like a good site and I'm adding it to my "Good Stuff" list for perusal on my days off.

Put THAT in Your Care Plan (NSFW)

"Mrs. A, I have your vaginal cream," the nurse said as she entered the room.

"Oh, you have cream for my cockroach?" Mrs. A asked.

(I had to stop breathing here so I wouldn't start laughing.)

"Your cockroach?" asked Nurse B.

"Yeah.  You know.  My hoo-ha," she said, waving vaguely that direction.

"It's not going to hiss at me, is it?"

"No.  It won't even bite."

***

How does that go in the care plan?

"Mrs. A refers to her vagina as her 'cockroach'.  All staff may refer to it in this way as well."

Seriously.

Goodnight Sugar

(My friend's been out of the hospital for a few days now.  She made it up to work to get her check without oxygen the other day, so she feels she's improving.  If the doctor releases her, she'll be back to work on Wednesday, at least part time, I'd guess.)

***

"Mrs. A, do you need your eye drops tonight?"

"No, my eyes are feeling fine.  All I need is some goodnight sugar and I'll be ready to sleep."

So I closed my drawers and locked my cart and went to give her a hug and a kiss.

***

There aren't many jobs out there where hugs, kisses and laughter are desirable.  You can't get this stuff working at McDonald's or in an office cubicle.  They might pay more in cash, but they can't touch it in emotional dividends.

Lack of Activity

Sorry about the lack of activity here.  It's not that I've run out of things to say, but a friend of mine is in the hospital. I've been taking care of her cats in the morning and so haven't been online much at all.  She's hoping they'll spring her tomorrow.  Once she's back home, I'll get back on track and post more regularly.

Opposite Day

If I didn't know better, I would think that I was dropped off in an alternate universe where everything you get is the opposite of what you expect.

The owner came to inservice and was appreciative and complimentary.  Not one disparaging comment during his entire speech.  He almost seemed sincere.

The new DON ran the meeting and it went quickly and almost painlessly.  And, we got carrot cake cupcakes with cream cheese frosting and candy pumpkins on top.

I got my check, it had the correct amount of pay on it and included my second week of vacation which I had asked to be paid out.

I'm not sure what I did to deserve a smooth inservice like that, but I hope I figure it out so I can do it again.

Changing of the Guard... Again.

So, as I'm walking into work yesterday, I see large pieces of furniture moving out the front door.

Our DON is leaving.

At the end of the month, our Administrator is leaving.

So, once the new ones are ensconced, that will be the fifth DON I've worked under and the fourth Administrator.  And I have only worked at this one facility and I've only been there three and a half years.

Really?

You know what's not changing?  (Well, as far as I know, anyway.) The owner.  And, frankly, from what I've seen so far, that means nothing is really changing at all.

Honesty

"So, Mrs. A, how do you like your new room?" I asked.

"Well," she said, "it's better than sleeping in the hallway."

Memorial Book

Losing residents is the nature of the nursing center beast. You learn to cope real quick. I've created a Memorial Book where I write down anecdotes about the folks I've lost. (I'd do this online, but, you know, HIPAA and all.) It gives me a chance to remember them and do a little crying without doing it at work. I also have a page dedicated to folks who I didn't get to know because they only came to the nursing home to spend their last days.

I could collect obituaries, but writing my memories about them seems to help me more than reading what someone else wants me to read. I write it, get it out, and then I can put it in a little box where it can't bother me unless I choose to open it up and let it out again.

Nursing Fashion

Whoever invented those hip-hugger pants and then expected people in nursing to wear them must like looking at butt cracks. I have to wear t-shirts under my scrub tops to tuck them into my pants so that everyone doesn't get mooned 45 times a night.

And is it sad that the most joy I got out of last night was pulling up a co-workers pants when she had an armful of books and was about to be seriously overexposed? I have to wonder what that says about me.

Parallels

We're constantly losing skin cells. We shed them a little at a time and we generally don't notice it. Sometimes we speed it up by scratching or exfoliating, but even then it's not uncomfortable.

Sometimes we get an abrasion. A rug burn. It hurts for a day or two, we put some antibiotic ointment on it and maybe a bandage and we go on.

Every once in a long while we take a tumble that leaves a deeper wound. We sit, stunned, watching ourselves bleed and we might even cry. This time we need to stop the bleeding, clean the wound and use a more serious dressing on it. Maybe even gauze wrapping to keep it in place. Now it hurts for a long time, affecting everything we do until we are significantly along the road to healing.

Losing co-workers is like this too, You have that layer that comes and goes and that you don't notice much. You have some that make you pause when they leave but you get over it. And then there's a few that go away that really affect you and make you re-learn how to work without them. Those are the ones you really miss. You heal eventually, but there's always a scar left behind to remind you of your loss.

NSFW...

...unless you work in a nursing center.

It doesn't take long before you realize that you have conversations in a nursing home that you wouldn't have in public. And certainly not as loudly.

"What can I do for you ladies?" I asked as I walked in to answer their call light.

"You need to call my daughter-in-law and tell her to bring me a bra. And not just any old one. I want the new black one without the cut straps," Mrs A told me.

"And she needs it. She has large, pendulous breasts. When I turned around yesterday and saw those things, I was shocked," Mrs. B said.

...

After I got my face arranged, I turned around and said, "Well, then she needs her bra then, doesn't she?" before I left the room.

Let Them Smoke

I live in Oklahoma. Rural Oklahoma. I don't have any official numbers, but smoking seems more prevalent here than northern Illinois where I spent most of my life. Often, when we get a new resident, they come to us with an order for nicotine patches. If they're able to protest at all, they have us remove the patch as soon as they arrive and refuse all future patches so they can go out on the back porch end enjoy their cigarettes.

The residents who are able to successfully kick the habit seem to lose their faculties faster than the ones who continue smoking. Before long the new non-smokers find themselves unable to get around without help when their still-smoking contemporaries are walking or wheeling out the back door.

I'm for letting them keep on smoking.

Having their cigarettes taken away seems to kill their motivation to get better or even stay at whatever stage they're at health-wise. Smoking isn't just smoking. It's independence. It's conversation and camaraderie. It's sharing. It's something to do that's not "old person" centered like some of the activities can be. (Bingo, anyone?)

You could make the argument that the resident is in decline anyway and smoking doesn't make any difference. Maybe. But of the people I've seen who have successfully quit smoking, more than half became bed-bound while their housemates who still smoke were managing to get up by themselves every day. Even if it was just to wheel themselves out for their next cigarette.

And then this happened...

I usually credit myself with being patient and thorough at work.

Last night at supper I took Mr. A's blood pressure and pulse and said, "OK, I'll be back in a couple minutes with your medicine."

I took off, got the meds, returned to him and he greeted me with, "Why are you in such a hurry?"

"I'm not. Why?"

And then I looked down and realized he was still wearing my blood pressure cuff.

Sudden Influx of Residents

A side effect to this monstrous heat wave we've been surviving has been an increase in our residents. When it's hot like this, more folks are going to the hospital and their doctors and families realize that they "aren't what they used to be".

Unfortunately, we're in that space between having an increase in residents and not having quite enough staff. It takes longer to do background checks and drug tests and all that stuff to get new staff in than it does to admit someone to the nursing center.

From a monetary standpoint, this is a better position to be in than having it the other way around. From a care standpoint, it makes the residents upset and the staff resentful. I'm looking forward to the pendulum swinging back to center for a little bit.

To My DON

I realize that you're busy and stressed. I understand that you have more on your plate than most people. I'm aware that each day ends with the same amount of things on your "To Do" list as you started with in the morning. And that's if you're lucky.

Still, when I tell you about an article that I've read and recommend it to you, it would be nice if you'd acknowledge it. If I make a suggestion, even if it's not feasible, I'd like to know you read it. You don't have to even explain why you're not implementing it. A simple, "I got your note," would work for me.

I believe that much of the complaining that we CNA's do is based on the feeling that we're just the "worker bees". We're expected to do the job without any questions or input. If we do say anything, it's just buzzing in your ears, easily shut out by closing your office door.

Just a little acknowledgement would go a long way with me. I'll bet at least a few of my co-workers feel the same.

Got Lost for a Bit

Sorry for no updates. Work's been kind of a bummer and even the funny things aren't really making me laugh.

Taking a few more days off and then I'll get some more blog entries up, probably starting Monday. I've had several wandering around my head, I just need to get them sorted out and written down.

On a sad note, the other day was a year since my co-worker Sherman passed away. We had a short electrical outage that afternoon at work. Sherman always used to turn out the med room lights on us when he walked past. It was probably a coincidence, but we attributed it to Sherman saying hello to us anyway.

Repairs Needed

"Honey?" Mrs. A called the CNA over to her table at suppertime.

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

"Somebody has to fix my head," she said.

"Your head? What's wrong with your head?" the aide asked, bending down for a closer look.

"Well, I'm crazy," she said.

Patting her shoulder, the aide stood up. "Oh, that's OK, hon. You're in the right place because we're all crazy here."

It's a Zen Thing

Last night at work it occurred to me that working in a nursing home is very Zen. From the little I've read, they talk about detaching yourself from expectation. So, you should work, but you should work without expectation of result.

So, just because you've taken Mrs. A to the bathroom, brushed her dentures, brushed her hair, helped her wash her face, put lotion on her hands, helped her to bed, adjusted the pillows, bed and blankets until she's comfortable, you shouldn't expect her to stay there.

Wait, that's not right.

After supper, Mrs. A sometimes plays piano. Last night she played The Star-Spangled Banner, Yankee Doodle, God Bless America and O Come All Ye Faithful.

Catch that?

So did she. About three quarters into the first verse, she stopped playing and said, "Oh no, that's a Christmas song," and started laughing so hard she had to quit altogether.

Molested!

"Mrs. A, what are you doing?" asked Mr. B who was at the nursing home visiting his dad.

"I'm patting your patties," Mrs. A responded and spanked him lightly again.

"Well, they're my patties and I'd like it if you'd leave them alone." Mr. B said. "Why don't you go pat his patties?" he suggested, pointing to a male CNA.

"No. Too big." she answered and sat back down in her chair.

Mamas Don't Let Your Babies Grow Up...

...to think you want to live forever.

Our capacity for artificially extending life seems to be growing by the day. If you don't let your family know what you want, undoubtedly they will do everything in their power to keep you alive. Even if it means feeding you through a tube surgically implanted into your stomach and inserting catheters and tubes into places that were designed to be "Exit Only".

If this is how you want to spend the last few years of your life, please, have at it. However, if the thought of laying in bed in the same position until someone can turn you, having someone clean you up after you soiled yourself and watching your roommate eat while they put fluids with vitamins in them directly into your stomach through a tube, please fill out a Living Will and any Advanced Directives before you think you should. If you wait until you become injured and/or sick, you may not be able to tell your family to let you go quietly. They may decide that you like living in this condition or that you will be "up and dancing in no time" if you can just get over this bump in the road.

I am all for hope. I believe in miracles because I have seen them. But my residents who have been on a downward spiral for several years deserve to be put under hospice care and allowed to meet their Maker with dignity. A little preparation in advance of catastrophe would allow them to do that instead of being forced to exist just because their families don't want to let them go.

Frustration Post

Rawr.

I find myself asking "Why?" so often that I think it might be the only sound I can make. Sometimes it's preceded by "I don't understand" when I'm making a statement.

For example:

• "Why can't the people who are scheduled to work, come to work?"
• "I don't understand why someone keeps bringing Mrs. A potato chips when she's diabetic."
• "Why don't they let a CNA attend the care plan meetings?"
• "I don't understand why the doctor won't prescribe better pain medication for this resident."

Today is my "hump day". After this, it's all downhill until my "weekend". I think I may make brownies to bring to work on my "Friday". Chocolate doesn't cure anything, but it sure tastes good.

Time Warp

"What are we watching?" Mrs. A asked her roommate.

"Lawrence Welk." Mrs. B answered.

"Lawrence Welk? I thought he was dead." Mrs. A said, sounding surprised.

"He is, honey. This is just a re-run." Mrs. B said, laughing.

O/T Eulogy for a Good Dog

Jubilee passed away on Sunday.

We got Jubliee and her sister, Annabelle, after we lost Sam eight years ago. Jubilee was the biggest dog in the litter, bigger than her brothers. She was a "reverse brindle" Boxer, so she almost looked like a giant Boston Terrier. She has always been the protector. Her sister used to sit or lay on her constantly. After Annabelle found a new home (an interesting story there, too), Petrucci, our male Boxer, took her place in using Jubie for a seat. She tolerated this pretty well most of the time. When she was done being a tuffet, she was done and she would let them know.

Jubilee was the one who would wash you with her tongue as long as you would sit still. If one of the other dogs was sick or wounded, "Nurse Jubie" was the one taking care of them. When Brad's mom was staying here, she had a key chain with a black and white stuffed cat on it that meowed when you pushed it's belly. Jubilee took that thing and carried it around and talked to it like it was alive. We often wished we hadn't gotten her fixed so that she could have had a litter of pups. She would have made a good momma.

While we're sorry to see her go, we're glad she didn't suffer long. Jubie was always a strong, healthy girl.

We miss you, Choob. See you on the other side.

Dr. Jack Kevorkian

I guess this is technically off topic, but I have something to say, so here I am.

Dr. Jack Kevorkian passed away yesterday. In the hospital and not by his own hand. It's kind of anticlimactic, considering the way he put himself on display with his suicide machine.

Dr. Kevorkian could have been an advocate for assisted suicide without acting the fool. If he had, maybe we would be farther along the road to legalizing euthanasia for human beings. Instead, "Dr. Kevorkian" is a punchline and we have people who are terminally ill, suffering, and are forced to watch themselves waste away instead of having a quick and dignified end. What a shame.

And that's all I have to say about that.

Just Wait

I got yelled at by a resident the other day. Loud. In front of an entire room full of people. I wanted to crawl in a hole. I don't mind being the center of attention if I put myself there. I don't like when someone else does it for me.

That was my last exchange with this resident for the entire day. So, with this unresolved mess in my head, I went home, ate and tried to get some sleep.

Right.

I woke up at 4:00 trying to think of what to say to the resident. I fell back to sleep about 6:30 and had the dogs waking me up at 8:00 and found myself thinking about it all morning. To the detriment of my workout and chores, because one didn't get done at all and the other was done poorly at best.

When I got to work, the aide handing off the cart to me told me that the resident had given her a hard time that morning, too, and that she had finally gotten out of the resident that their stomach was bothering them. So, when it was my turn to talk to them, I asked how their stomach was, did they want their meds now and if not, can I check in with them later.

Not so good, no and yes.

So, I let this rent space in my head for nearly 20 hours, stressing out over what to do and all I really needed to do was relax and wait for the answer to present itself.

Lesson learned. Now I hope I remember it the next time I find myself in that space.

Glad to be back.

I've been back at work for two days. My residents seemed to be glad to see me. I was glad to see them, that's for sure. Sadly, when you take vacation, you sometimes come back to find someone has passed away. That wasn't the case this time. Everyone is intact and there are even a few new faces in the facility.

On the other hand, when you go on vacation, you hope that some of the things that weren't working so well will have resolved themselves by the time you return. Unfortunately, I'm not seeing any of that either. Oh well. At least there aren't any glaring new problems.

A couple more days here and I should be able to collect some stories to tell. The other thing about returning from vacation time is that you have to get back into the swing of things and I'm not quite there yet. I'm having enough trouble getting my work done without trying to scribble down every funny thing I hear, too.

I'm Off

I am taking a week of vacation.

I hope I do not think about work while I'm away.

Since I don't plan on thinking about work, I don't plan on writing about it either.

See you after Memorial Day.

Honesty

"What are you doing?" Mrs. A asked when I knocked on her door.

"I need to give Mrs. B some medicine," I answered.

"Oh god! Please don't wake her up! She's finally sleeping and when she's awake, she drives me crazy."

Today is Pajama Day

We're having a kind of Spirit Week for Nurses Week at work. You know, we've done the hat day and crazy sock day.

Today is pajama day.

...

I am really glad I have today off.

Still More on Roxanol...

...and comfort care.

From the very little that I understand about the legal side of nursing, Durable Power Of Attorney (DPOA) is something you give someone who agrees to make important decisions for you when you can no longer make decisions for yourself.

So, your DPOA can decide to put you on hospice and have you receive comfort care only. They can say that you wouldn't want to suffer and that it's ok to do this. Sometimes this speeds up the end, sometimes it doesn't.

In any event, what if the resident's DPOA wants hospice (and therefore is vicariously speaking for the resident) but other family members want to do everything possible to keep the resident alive? Talk about a touchy situation. The family is fighting. The resident is sick and confused and gets combative when the "live forever" side of the family is in the room and is sick and confused and angry with the "rest in peace" side of the family is there. Regardless, you almost have to grit your teeth, focus only on the resident, and get out of the room and quickly as possible. There's no way you can satisfy the family's loaded questions, so you have to resort to referring them to the charge nurse. They don't like that either.

Sadly, it makes you wish the resident would pass away faster and that's an awful feeling, too. So here we are: feeling guilty for wishing the end would come, feeling guilty for giving comfort care, and feeling guilty because we are too uncomfortable to stay in the room for one second longer than required to do our jobs.

And here I thought this job was just about keeping people happy, healthy, and comfortable.

More on the Roxanol Question

When a resident is in a great deal of pain, the doctor will sometimes prescribe Roxanol. This is liquid morphine. It works fast, but it does not last very long, so we sometimes have instructions to give it every thirty minutes, as needed.

We have a debate every time this comes up. For some reason, no one wants to be the one to give that last dose of Roxanol before the resident dies. I don't get it and I don't have a problem with it. If I am giving it according to the doctor's orders and the Hospice Nurse and the Charge Nurse are aware of it, I'll be there with it when the resident needs it.

But, what if the resident doesn't want it?

The simple answer is not to give it. Yet, if they are curled up in the fetal position, refusing care, and crying because they are in so much pain, then what? Do we let them suffer, because that's what they want? Or do we cajole them into taking the pain medication, even though it may speed up their end? And, further more, if they let us give it, do we then keep them snowed to prevent them from hurting or do we wait until they are crying again before we give it?

Welcome to my position between the Scylla and Charybdis.

There's a cure for that?

Mrs. A went to the doctor and had some X-rays taken. I asked her how the visit went.

"Oh, they asked me if I had all kinds of diseases. Then they asked me if I had the menopause. I said I didn't know. But, you know, I think I had it once and it all cleared up."

Drawing the line

Duty comes first. It is my duty to show up for work when I'm scheduled and to give 100% of what I have to give that day. Sometimes my 100% varies, but I show up and try to do my best. I don't think I was always wired this way, but I have been for the last ten years or so. I acknowledge that it makes me intolerant of people who I perceive do not operate this way. I also acknowledge that I should strive to be more kind and understanding when my co-workers disappoint me.

However, I draw the line at covering for them.

I'm not saying that I have never worked an extra shift on short notice, but I avoid it like the Plague. My reasoning is this: I work my schedule. I avoid calling in unless it is impossible for me to go to work. I have, more than once, called work and had them send someone to pick me up because my car has broken down. I work when I'm under the weather and injured. While I don't really expect everyone to be exactly like me, I don't expect them to call in more than ten times a year (multi-day illnesses count as one in my mind), either.

Once you say "yes", the powers that be start calling you to come in all the time. You become the "go-to girl". Pretty soon you can't count on getting a day off, ever. I don't know if this is true of every facility, but that's how it works at my workplace.

I'm not interested. I don't care if it means overtime pay. If I start doing this, I'm going to wear out and then I'm going to be the one calling in sick or injured. I'd rather be the girl that they can rely on to be in when scheduled. I draw the line at trying to be SuperAide.

Rumors abound.

I'm hearing rumors about a not-for-profit nursing center opening up in town. I'm not sure where we're going to find residents to fill it up since we can't even fill up the two we have in town now. But both of the ones in town are for-profit, so maybe this will attract more people.

Anyway, I'm planning on jumping ship if they do open. And, yes, I'll take a cut in pay to do it.

Slightly OT: We're all going to die.

Hopefully, not today, but eventually, we're all going to die. It's the one thing you can't escape. You can even get out of paying taxes if you really try, but death? Sorry, you don't have a choice.

So, if you're wondering what brought on this spate of vitriol, here's the story.

Grete Waitz passed away. She won nine New York City Marathons. She had been battling cancer for the last six years and she died on Tuesday. I saw the news on About.com this morning. There were two comments, both expressing amazement that someone that young could have died. They expressed their condolences to her family and then each made a comment to the effect of, "Wow, if an athlete can die so young, why bother trying to be healthy?"

Really?

Quality of life is greater than Quantity of life. Sure, you can live to be 100, but if you struggle and suffer through the last 50 years, is that really what you want? Frankly, you can have 40 of those years if the rest of my life is relatively free from pain and disease.

Yes, I know, that's just my opinion. But after working in the Nursing Center for the last three years, I feel pretty qualified to offer it up for scrutiny. I've had enough people tell me that they wished they were dead to believe them.

I didn't know Grete Waitz. I've never even read an interview with her. But I'm pretty sure that she wouldn't say that she wished she had never started running. I imagine that she regrets that she didn't get to run more.

Amazing scenes and nightmares...

... and everything in between.

***

When I came on shift the other day, I heard singing. This isn't unusual. We have our fair share of volunteers who come in to entertain the residents. What was unusual was that this was a private show.

Mrs. A was laying in bed, hands raised and waving, as one of her male family members was singing a rollicking spiritual while dancing and playing the ukulele. It was the most awesome thing I have ever witnessed. There is a special place on the other side for this guy.

***

We had CPR class the other day. Mr. B was wheeling around in his own little world and, since the meeting hadn't started yet, we were letting him.

The next thing I heard was, "Hey! Mr. B 'jacked the mannequin!" and turned to see him wheeling out of the dining room with it on his lap.

***

I went into Mrs. C's room to administer her bedtime meds. While I did this, Mrs. D sat up and started getting out of bed.

"What time is it?", Mrs. D asked.

"Eight o'clock at night," I answered.

"At night?" Mrs. D laughed.

"Yes. Did you think it was morning?

"I was dreaming that we were voting on whether or not to quit that war over there. And then I dreamt that I was elected president. I guess that's what woke me up," she said, still laughing.

"Well, I don't blame you. That would wake me up, too."

Compassion Fatigue?

Mrs. A can no longer speak. She still manages to make a lot of noise. Yesterday, she was sitting by the nurses station, letting us all know she was there.

Mrs. B was sitting in her wheelchair several chair-spaces away. Every time Mrs. A would slow down, Mrs. B would chime in. "Can you shut up? I wish you'd shut up," and other variations on that theme.

Yes, it's sad that I find this funny. (We did move Mrs. A to the dining room after that, so Mrs. B wasn't being tortured for hours on end.)

I'm gonna wash that gray...

...right outta my hair. (Remember that commercial?)

Or not.

I have this bad habit of speaking my mind. Yesterday I was talking with a resident's family about a couple of co-workers who had recently dyed their hair... um... unusual colors.

"If I was meant to have hair of a different color, god would have given it to me," I said.

Yeah. In the room with two ladies who dye their hair.

I wonder if I ever will learn to think before I say stupid stuff.

Speaking of gray hair... the other night I was washing my face when I saw a white hair sticking straight up from the top of my head. It was about a half inch long. I have three dogs, so I thought maybe one of their hairs had gotten stuck in mine.

Nope. It was firmly attached to my head. And it had a partner about two inches away from it, also standing up on end. I had to laugh, because they looked like tiny horns growing from my scalp.

How pushy is too pushy?

One of the really fun things we get to do is convince people to do things they don't want to do. Sometimes this is just a matter of re-approaching them. Sometimes it involves a bribe. Sometimes you just have to do it and apologize later.

But at what point does "No" mean "Go away and don't bother coming back today"? I had to pass meds yesterday to a new resident. 40 minutes (and no, I am not exaggerating: 1800-1840) I got about 2/3 of it out of the cup but I'll bet she spit out more than half. At one point, she started coughing, meaning she could have aspirated if I had continued.

I told the charge nurse we need to do something because A.) I cannot spend 40 minutes with one resident and B.) She has the right to refuse, even though she's not completely in her right mind and C.) If she does aspirate, then I'm to blame, even though the family really wants her to take her meds.

We're constantly walking a fine line between abuse and neglect. I don't care what you say, it's true. 40 minutes cajoling and slipping little bites of medicine in a resident's mouth could be construed as abuse. Not giving her the medication could be construed as neglect. Same thing with a resident who doesn't want to be bathed even though she clearly needs it. If you force her to be bathed, even with a bed bath, it could be abuse. If you let her lay in her own filth, you are guilty of neglect.

My solution is to get the charge nurse involved. Not just tell her about it; make her come with you and see what is going on with her own eyes. Ultimately, she's your shield and if she sees what's going on, she should either offer suggestions or back you up when you just can't get the task accomplished.

(Yes, sometimes I use this blog to think things through and figure out the best course of action.)

Step away from the rumor mill.

The DON at my facility seems to be still firmly ensconced in her office. Although the next inservice should prove interesting.

I received two really good lessons on not playing in the rumor mill yesterday.

The first was when I heard story A from one of my third shift co-workers. She made it sound like the third shift charge nurse and the CMA from that shift got in an argument over dress code and the CMA was being belligerent. When I got the rest of the story, it turned out the CMA was not arguing with the charge nurse, but asking a question about the dress code. (My third shift co-worker does not like the CMA on that shift.)

The second was when I was told that the DON got rude with a resident's family and that it resulted in them moving the resident out. Turns out what really happened was that the family was just waiting for the doctor to write the discharge order and the DON helped facilitate that. Unfortunately, the resident's family wasn't entirely ready for the resident to be discharged, but they were complaining that they were waiting for the discharge order so they could take their family member home. (From the "be careful what you complain about to whom" file.)

Most of the time, things are not what they seem. Perception is reality and it's amplified tenfold in the rumor mill. You have to choose between plugging your ears or listening harder for what else is being said.

You know you're in for a bumpy ride...

...when someone compares their day to the movie Bad Day at Black Rock. (Feel free to Google that. I had to.)

I received a text from one of the girls (OK, "ladies", since she'd have to be older than me to be familiar with that movie) that I work with containing that reference. I told her she was making me really excited to go back to work on Saturday.

The blessing about working the weekend is that I miss a lot of the Monday-Friday drama that goes on. My current schedule is Saturday - Wednesday, so I get the quieter weekend and then I have my days off when the office crew is getting tired and cranky.

In any event, it sounds like today will be interesting. We may be going through a DON change if the rumors are true. Again. I've been there three years and have had as many Administrators and DONs. Although, this pair has stayed on the longest.

All I want to do is go in, take care of my guys and dolls, and go home. I don't really want to hear about a bad day before I get to experience it personally. Sometimes the fear of the ride is worse than the ride itself.

Preexisting Condition

"Is tomorrow Tuesday?" Mrs. A asked me last night.

"Yes. Tomorrow is Tuesday, March 8th. Fat Tuesday."

She looked down, laid her hand on her belly and said, "Well, I'm already that way."

You can't always get what you want...

...but sometimes, you get what you need. (Hope you don't mind me paraphrasing the 'Stones.)

What I want is to work with a full crew for a full shift. I realize this is asking too much. Still, one can always aspire for perfection.

That said, Mrs. A rolled up to me in her wheelchair after supper as I was desperately trying to get my med pass finished.

"Dr. Tracy, I'm going back to my room and I'll have to wait for a while before they can come and help me to bed." (She calls me Dr. Tracy when I'm passing meds.)

"I know Mrs. A. I'm sorry."

"You know, there's a bible verse. I think it's in James. The beginning of the verse says 'If anyone considers himself religious and yet does not keep a tight reign on his tongue, he deceives himself and his religion is worthless'." (She's quoted this to me before and it always makes me think she's overheard me swearing.) "But the second part says, 'Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress...' That's what you all do. You could work anywhere else, but you choose to work here and we are thankful for everything you do and everyday you are here. And the next time someone gets in your face, you tell them, 'Hold on, buddy. My Father in heaven is proud of me and all I do'."

I thanked her and gave her a hug and went back to running around like a decapitated hen. For the rest of the shift, I felt like Wonder Woman.

Bonus

I occasionally get residents who want to pay me for my services. I turn them down and explain that I already get paid. This usually gets me something along the lines of "it's not enough for what you do".

I call shenanigans.

No one does this kind of work because they want to get rich. Yes, we're trying to support ourselves and our families, but generally we do this because we get some kind of joy out of it. If we didn't, no amount of money would be enough.

I don't need a bonus. Unless they can convince my co-workers to show up when they're scheduled. That I'd take in a heartbeat.

Back in the day.

Sometimes I wonder what my ladies and gents were like before they came to the nursing center. I can read their charts to find out their medical history and what they did for a living before they got hurt, sick or just wanted to retire. But their charts don't tell me what their favorite cookie is or who they looked up to as a kid or whether they prefer showers or baths.

Once in a while I'll get a little glimpse of who they were. Mrs. A told me one day that she loves toast with jelly dipped in her coffee. I do, too. Mr. B and I talk about playing poker and smoking marijuana. (I play poker, but marijuana is not on my list of vices, so I mostly listen when he talks.) Mrs. C used to be a CNA and, even though she can't tell me about it, I'll bet she was one of those who could move a resident no matter how heavy they were. Mrs. D and I talk about Boxers because she used to have two that would walk with her around her property and she says she was never worried about meeting up with a varmint while they were beside her.

It's easy to forget that these folks had lives just like we do before they became too disabled to care for themselves. They had their share of tears and laughter, joys and regrets. Sometimes, if we're lucky, we get to hear about some of them.

In the rush...

... to get everything done, I sometimes forget why I like my job.

Last night I was pushing pills. I had a new resident to introduce myself to, which I did, medicated her and went on. Because that's what I do and what I HAVE to do to get everyone their "supper" pills before I have to start passing their "bedtime" pills.

New resident doesn't have any bedtime pills, so I don't go visit her and complete my med pass, finishing up just before nine pm.

When I'm done passing meds, I take a break. Sometimes, like last night, it's the first break I get. (Yeah, yeah, don't talk to me about "two 15 minute breaks and a 30 minute lunch". If that happens for you everyday at your facility, I'm happy for you. I get that once a week for sure, more if I'm lucky. This is not a complaint, just a statement of fact. Frankly, I do better on fewer breaks.) About five minutes in, I get a request for prn medication from the new resident, so I trot down the hall, to fix her and then try to scoot back to break.

She called after me, asking for a snack. I told her what we had, got her order and trotted back with juice and one of every cookie/cracker we had because the "good" cookies that the kitchen bakes were all gone.

While I'm getting ready to leave, she starts giving me her health history for the last six months. So, I listen, still standing. (If I knew her better, I would have sat down, but I don't know how she feels about staff in her room yet.) We chat about physical therapy and about how they will get her back on her feet and I suddenly remember that the reason I like my job is because something as simple as giving a person an ear to bend can make all the difference in their world.

My goal today is to remember this more than one time before 9:30 pm.

Off Topic: Dogs

I can't remember when I last wrote about anything other than the nursing center...

Cliff, our terrier mix, is more intelligent than 50% of the people I know. The prize spot in the house to lay is the love seat. Only two dogs, or one human and one dog fit on it at a time. If Cliff is the "odd dog out", he will run to the lanai door, barking like every bad person in a six mile radius has converged on our backyard. When the other dogs follow him, he turns around, runs back, and lays down on the love seat.

I wonder if Jubie and Trucci will ever catch on.

And so the pendulum swings.

We seemed to be in the business of losing employees there for a while. Now, suddenly, we've got a bunch of former employees coming back. Good ones, to boot.

Have I ever mentioned how much smoother things go with the right group of employees? Even on nights when we're short-handed, it's so much easier when everyone can work together. Then we don't end up with a time where everyone is stubbornly on break at the same time or one hall gets all the attention while the other hall's residents are left in the lurch.

Last night was one of those nights. Even though we had an employee leave early, we still were able to take care of everyone with hardly a glitch. (Well, except for the woman who was trying to hit people with her doll. But that's another story for another day.)

***

Quote of the day:

"What are you up to, Mr. A?" the CNA asked.

"Oh, just waitin' for my celly."

(I know. Another prison reference. I still found it hilarious.)

I'm sick...

... so if I'm repeating myself, blame it on my cough-rattled, mucus-filled brain.

***

One day while the ladies were doing arts and crafts, Mrs. A asked Mrs. B to pass her a blue dot.

Mrs. B handed her a red star.

"No. I asked you for the blue dot," Mrs. A said.

Mrs. B cocked her head and for a moment, handed her the red star and started singing, "The old gray mare, she ain't what she used to be..." and was quickly joined by the rest of the table before they broke down into giggles.

***

Now, ask me if I'm going to work today. Yes, I am. My temperature is not over 100, I am not vomiting and I do not have uncontrollable diarrhea. I'm donning sinus pills and Mucinex as my battle armor and heading into the fray.

Been in a work funk.

Work's been kinda rough lately. Rather than getting on here and complaining, I thought I'd take a break. Between the weather, sick residents, and sick staff, I've been up to my eyeballs in frustration. I'm taking a couple more days to straighten my soul out, then I'll be back. Some funny stuff has actually happened amongst all the muck.

Care to vote on the quote of the day?

"You came into my life, then I thought I got rid of you. Now, here you are again, but I'm glad of it." --One old friend to another, who are now roommates at the nursing center.

or

"We'll be alright as long as they don't start screaming...one after the other... in three part harmony." --Said to me in the dining room during a relatively quite meal.

***

Personally, I'll take the second one. It kills me when they're catty.

Fashion Police

"That's such a pretty dress you have on," said Mrs. A to Mrs. B

"Why, thank you! Santa Claus brought it to me, plus three more," Mrs. B replied, smiling.

"It's a good thing he did. You can't buy a dress like that anymore. They're all down to your boobs and up to your butt," Mrs. A said, pulling up the bottom of Mrs. B's dress to illustrate her point.

Mrs. B laughed a little.

"I'm serious. Haven't you seen those girls on TV?"

Fighting Dehydration

One of the hardest things to do is to get my ladies to drink enough. I try to get them to take a full glass of water with their meds and they have big mugs of ice water in their rooms. Some of them do OK on their own, but most of them need to be encouraged to drink.

And they don't like water.

I don't either. Give me a choice, and I'll pick something flavored every time: tea, coffee, milk, juice, pop. Water is strictly utilitarian and I only drink it because I "have to".

I've started offering a couple of them juice with their medications. I'm also trying to take time to sit with the ones who can't hold a glass well and get them to drink while I talk with them. Sometimes I'll take break with one of them and bring them coffee or tea to drink while we're chatting. Unfortunately, these are more the exception than the rule, but every ounce helps, right?

Bizarro Nursing Center

Everyone is behaving backwards lately. The nice ones are snarky and the mean ones are saying "please" and "thank you".

I was talking to Mrs. A (known to her doctor as "Meanness") the other day about how everyone seems off. Teasing, I asked "Are you normal?"

"No. How can I be when everyone around me is abnormal?"

Well, I bought new shoes...

...and I'd like to say they made a world of difference, but, alas, no.

Unfortunately, I think I have pounded my feet to death the last month or so in those old shoes. I figure it may take at least that long for them to stop hurting with the new shoes. I also started some foot and ankle stretches last night. That's probably something I should have been doing a long time ago, too.

On the bright side, the new shoes didn't cause any new pain, so I figure that's a plus.

And into the trash they went

OK. The shoes had to go. Considering I only spent $13.00 on them, they lasted a long time. I think I should have gotten rid of them a couple months ago, however.

I'm planning on spending good money on a new pair next week. In the meantime, my running shoes are doubling as my work shoes. And since I spend a lot of time running at work, it's fitting.

***

We have a new lady who can no longer speak, but cries out a lot. I'm hoping this will stop once she gets used to her new home.

The other day, Mrs. A was interrupted by a howl from Mrs. B.

"I'm glad that's not me," Mrs. A said (who has been known to let out a scream herself, now and again).

(Mm. That might be a "location" joke. But I thought it was hilarious.)

The Short-handed Shuffle

Oklahoma is one of the states that has a minimum staff requirement for nursing centers. It sounds great until you realize that the staff that they can "count" are not necessarily staff that are working the floor.

We were short again last night. Short by my standards. I would like to see 6 CNA's, 2 CMA's and 3 LPN's. We had 4 CNA's, 2 CMA's, and 2 LPN's. According to the staff requirements, that's enough people to take care of the number of resident's in my facility. The nurses don't work the floor and the CMA's are limited by what they can do between dishing out medication. (Technically, they are not supposed to stop their med passes to help out on the floor, but they never get through a med pass without taking someone to the bathroom or helping someone to bed or something.)

I understand that I should be thankful that the state has minimum staff requirements because it's likely that we wouldn't have had even that many if they didn't. (I work for a "for profit" nursing center.) But we would have been more effective if we'd had more help. Minimum staff just means the resident's are getting the minimum amount of care. In some cases, barely that.

I've been trying to think of a solution. I'm sure that if someone asked the Administrator, she'd say that her nurse's and CMA's help out on the floor. This is not usually the case and when they do, the help is limited as they have to get their work done too. Maybe the state needs to require a certain number of staff who are specifically dedicated to working the floor, regardless of their title. That way, a nurse could stand in for a CNA only if she was not also required to perform LPN duties.

In the meantime, I use my feet as a barometer. If they really hurt at the end of the night, we didn't have enough help. They were still tender this morning. (Yes, I also need new shoes, but that's another post for another day.)