Sunday, December 25, 2011
Monday, December 12, 2011
I walked into Mrs. A's room. She wasn't there, but her walker was. I knocked on the bathroom door.
"Mrs. A, are your legs still bothering you?"
"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.
Sunday, December 11, 2011
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.
Tuesday, December 6, 2011
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.
Monday, December 5, 2011
"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".)
Sunday, December 4, 2011
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.
Saturday, December 3, 2011
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!"
Friday, December 2, 2011
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.
Thursday, December 1, 2011
"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."
Saturday, November 26, 2011
"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."
Wednesday, November 23, 2011
Wednesday, November 16, 2011
"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.
Thursday, November 10, 2011
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.
Thursday, November 3, 2011
- 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.
Friday, October 28, 2011
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.
Wednesday, October 19, 2011
Sunday, October 16, 2011
"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."
Sunday, October 9, 2011
"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.
Friday, September 30, 2011
Friday, September 23, 2011
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.
Sunday, September 18, 2011
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.
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.
Sunday, September 11, 2011
Friday, September 2, 2011
Wednesday, August 31, 2011
Sunday, August 28, 2011
Wednesday, August 24, 2011
Sunday, August 14, 2011
Sunday, August 7, 2011
Saturday, August 6, 2011
Wednesday, August 3, 2011
Friday, July 29, 2011
Wednesday, July 13, 2011
Sunday, July 10, 2011
Monday, July 4, 2011
Friday, July 1, 2011
Thursday, June 30, 2011
Monday, June 27, 2011
- "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."
Friday, June 17, 2011
Monday, June 6, 2011
Saturday, June 4, 2011
Wednesday, June 1, 2011
Tuesday, May 31, 2011
Friday, May 20, 2011
Monday, May 16, 2011
Thursday, May 12, 2011
Wednesday, May 11, 2011
Sunday, May 8, 2011
Thursday, May 5, 2011
Friday, April 29, 2011
Sunday, April 24, 2011
Wednesday, April 20, 2011
Friday, April 8, 2011
Monday, April 4, 2011
Thursday, March 24, 2011
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.
Sunday, March 20, 2011
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.)
Wednesday, March 16, 2011
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.
Monday, March 14, 2011
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.
Tuesday, March 8, 2011
Sunday, March 6, 2011
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.
Wednesday, March 2, 2011
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.
Thursday, February 24, 2011
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.
Sunday, February 20, 2011
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.
Saturday, February 19, 2011
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.
Thursday, February 17, 2011
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.)
Sunday, February 13, 2011
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.
Sunday, February 6, 2011
Tuesday, January 25, 2011
"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.
Tuesday, January 18, 2011
"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?"
Monday, January 17, 2011
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?
Tuesday, January 11, 2011
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?"
Saturday, January 8, 2011
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.
Wednesday, January 5, 2011
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.)
Sunday, January 2, 2011
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.)