First Christmas in a new "home".

One of the ladies needed a sympathetic ear to bend the other night. She was talking about not being able to do the baking she always did for the holidays, not being able to go out to see her sister on Christmas, and just the general funk she was feeling about being a "cripple". I agreed with her that the first Christmas in a nursing center is a tough one. All the things that you used to have are gone and you're left with what will fit in a space the size of a small bedroom.

We can help them by encouraging them to attend the activities that they can. Take them to the dining room for supper. Bring them to the sun room or outside if the weather is warm enough. The bright side is that our facility seems to do a great job bringing people in to sing, dance, and otherwise entertain the residents. We also do an angel tree so each employee buys a secret Santa gift for a resident. Extra hugs and smiles go a long way, too.

Another way we can help is by taking care of ourselves. Getting enough rest, eating our veggies, and not drinking too much are all good ideas. Tired, over-sugared, and hung-over Nursing Assistants are not able to lift their own spirits much less those of their resident's.

This is my last blog post until after the New Year. Everyone have a safe and happy holiday, whichever one(s) you celebrate. See you on the other side.

Why not?

I wear gloves when I'm administering eye drops, nose spray or ear drops. Aside from the fact that it's what we're supposed to do, I don't like getting that stuff on my hands and sometimes the bottles leak.

I currently have a resident who's family member points out to me that they never use gloves to administer eye drops every time I put mine on. Every time I explain why I wear them. This adds up to ten times a week.

Next time they tell me that they never wear gloves, I'm going to ask them "Why not?" Change it up a bit. Maybe they'll get the point after the tenth explanation. Or, maybe not.

Head Shakers

Sometimes you hear things that just make you smile and shake your head.

"You know what's wrong with her?" Mrs. A asked me, pointing to her roommate.

"No. Do you?"

"Yeah. Nothing. That's what's wrong with her. Nothing at all."

***

"Oh, don't take that out," Mrs. C said to the CNA taking out her hearing aid after she'd been put to bed for the night. "I might miss something."

***

"Now, girl. You know I just vomited in there," Mrs. D said to me. After I had given her all her pills and was taking out her trash because it was full.

It would have helped me more if I had known this before I filled her with more medicine.

Shortly after I left the room, I found out why she had vomited. The CNA comes running out of the room with a tube of lotion. "Nurse E! Mrs. D said she ate some of this. She said she thought it was ice cream!" (We have a case of the stomach flu making the rounds of staff and residents. I assumed she was just getting ready to take her turn. The resident was OK and had no other adverse reactions. She had only licked the top of the tube. Lessons learned: Never assume and don't leave things that are not food on the resident's tray table at suppertime.)

I'm not looking forward to Monday.

The owner is coming to "talk" to us.

The last two times the owner came to talk to us, he fired people.

This may fall right in with the staff cutbacks. Hell, if you fire the DON or the Administrator, you save a lot of money on salary.

Sorry, I'm feeling cynical today.

Ultimately, my loyalty is to the residents. They are why I go to work everyday. Five years from now, the care I give them will still matter. Unless he's closing the facility, anything he says or does will be water under the bridge.

Work as Therapy

Without giving any details, let's just say that three of my coworkers (all related to each other) have suffered catastrophic changes in their lives recently. Two of them have not been back to work yet, due to health reasons. One has come back just because she had to, but she probably would have stayed home if she could.

When we were talking about this on break the other night, one of the nurses was talking about how the gal who came back to work should have stayed home. My response was, no, she needed to come back to work because she was really going to need the money. The nurse said she needed the time off for grieving, that she was due three days off. (We don't get paid for this.)

At that point, I stopped talking. The more I thought about it, the more I thought that I was right. Having three days off doesn't make the pain go away. This was not a situation where she would have to handle any legal issues due to the death. Sitting at home is not going to make her feel better or pay her bills. On the other hand, working will ensure that she has a full paycheck and taking care of the residents will help her feel needed instead of helpless. Also, some of the resident's who are "with it" know what she is going through and would likely offer her support. There's more to gain by coming to work than not.

I've always felt that work was a refuge when things weren't going well at home. I think this is especially true in the Nursing Center environment. Staying busy and feeling needed go a long way toward taking your mind off your troubles. And not having to stress about a short paycheck is just an added bonus.

Watching them burn out or fade away

I am generally assigned to the same hall. Once a week or so, I get bumped to another hall, so I don't see those resident's regularly.

Boy, you really notice changes when you only see them once a week.

Ms. X has been at the nursing center since before I started working there. She wasn't in good shape when I started, but she has been slowly declining until recently. Now she's taking a nose dive. Unfortunately, she knows it and is becoming more and more demanding. I used to be able to appease her 90% of the time (something I took pride in). If I can get her comfortable and happy for 50% of the time now, I'm doing better than average. She's going to burn out v/s fade away.

The resident that I wrote about being in the room when they passed, faded away. It was a quiet thing. Ms. X is going to be asking for everything she can think of until she can no longer speak. I had another resident go this way and I've been drawing parallels since last night.

Whether they burn out or fade away, it's still hard to watch them go.

Staff Cutbacks

We've had three med aides on my shift for several months now. Now they're making noise about cutting us back to two again. I've noticed that even though I've offered to let someone in Administration shadow me for a shift when I have to do this, none of them want to do it. Never mind the fact that it's a lot more running. In order to finish even close to on time, I have to start thirty minutes early and do "illegal" things to cheat to get done.

Grr.

That said, they are also saying that they want to increase the number of CNA's to almost double what we normally have. AMEN. I'll run my legs off and figure out how to be more efficient if it means that my residents will always be clean, dry, comfortable, and relatively happy. No one else seems to be on my side, but I'm pretty sure that at least some of them secretly agree with me. And the more happy residents we have, the more residents we will have. And State inspections should go much better.

There is a huge upside to this. If they actually give us more CNA's. If all they're doing is blowing smoke up my scrubs, then we're going to be worse off than we are now.

Thoughts X 3

Sorry I missed last week. I tried several times to put something down, but it just wasn't happening. I was going to write about my experience of being in the room as one of my residents crossed over, but the truth is that there was nothing to say about it. I was sad, but not unduly so. We were aware that the resident was going to pass, so it wasn't an emergency or a surprise. They went quietly; just a couple gasps as their soul left their body. The family was there and so was their Pastor. We were praying as they left this world. Really, as first experiences go, it was unremarkable. Frankly, watching them pass was much easier than the previous week had been, watching them struggle for breath.

On a separate note, there are some people who just shouldn't be working in a Nursing Center. I think you need to be soft, forgiving and willing to absorb a little abuse. These loud, brassy, hard-edged types really should be working in a mental hospital or a prison. There's no place for that in a Nursing Center. But in an environment where we're desperate for help, I guess we can't be too choosy. I do sometimes get tired of trying to smooth over the ruffled feathers, though.

Final thought. We were asked to do a time-study for our position and shift. Because I like to do these kinds of things, I just did one for all of us. We all signed it, so they would know we all approved it. Still, this smacks of them wanting to reduce staff. While I admit it isn't impossible to work with two med aides, it's significantly more difficult. It also means that I don't get to take a lunch break most days. I'm hoping that this is not the case. The DON said it was so that she could update job descriptions. I guess I'll wait and see.

Boxes

We do like to put things in boxes, don't we? It doesn't much matter what it is, if there's a place for it, we're going to put it there. If there's not a place for it, we'll make a place for it and shove it in there.

One of those lovely surveys came out recently that said Oklahoma nursing centers were among the ten worst in the country. Wow. That makes me feel proud. So, by association, am I among the worst ten percent of the aides in the country? I hope that's not true. When my residents tell me they're glad I'm working, does that mean that I'm merely the best of the worst?

Another question is how will this affect me in the future? If we decide to move out of state, will other nursing centers look down on me based on where I was trained? Would I be unable to get a job in, say Oregon, because of where I come from?

I don't like being put in a box. On the other hand, I do it to other people and things all the time. It's so easy to be judge, jury and executioner, but I don't like being on the receiving end.

This, that and the other.

Ironic item of the week:
I have a resident with dementia who has a tube of perfumed lotion called "Reality" sitting on their bedside table. Honest. I can't make this stuff up.

Two firsts:
I had a resident nearly splash my shoes with vomit. I literally had to jump out of the way.

I was in the room when one of my residents passed away. I haven't had time to sort my feelings out on it, but I'll be blogging about it eventually.

Questions of the week:
Why is it so hard to come to work? Seriously. And where do these people get the money to survive? If I don't work all my shifts, I'm screwed financially. How can you miss two or three shifts a pay period and still get by? How can you miss one shift? (And no, we don't get sick pay.)

Pillow v/s Shield

So, as usual, we have new nurses. It takes a good four to six weeks to learn your residents. The pictures in the treatment books are nice, but sometimes it can be difficult to tell one from another. Especially if there has been a great physical change in a resident since the photo was taken.

Well, Nurse Noob tries to administer a breathing treatment to Resident A. Unfortunately, the breathing treatment was for Resident B. Resident A is cognitive and doesn't have a nebulizer anyway, so the error was caught before it went too far.

Can I say that I got an earful? Can I also say that Resident A is deaf and speaks loudly? And furthermore, Nurse Noob is in the hallway, just a door down, probably dying of embarrassment.

I probably should have said something in her defense. Instead, I decided that my responsibility was to the resident. So, I nodded and agreed and listened sympathetically. I don't remember if I went so far as to apologize for Nurse Noob. I may have. In any event, I figured I'm paid to be a pillow for the residents, not a shield for the nurses. I may come to regret this course of action. But I'm confident she'll eventually get her resident's straight and Resident A will eventually forgive and forget her error. Eventually, all will be well.

WWRXT*

*What Would Resident X Think?

Whenever I'm making a change in my appearance, wardrobe or routine at work, I always try to see it from Resident X's point of view. Resident X is my benchmark. If I think they won't be able to handle the change, I seriously reconsider my position.

Resident X is my most difficult patient. They have severe dementia with behavioral outbursts. They don't like new staff or residents. They don't like being told what to do. They don't want anyone doing anything they don't approve of first. If the weather's bad or the moon is full or they're sick, their world rocks and crumbles.

For example, I'm planning on getting new glasses soon. Some of the chunky new styles are cute, but I will probably stick with simple wire frames just because I don't want Resident X to think I'm someone new. It took me nearly nine months to get them to recognize me on a daily basis. I don't want to have to start over.

Is it extreme? Yes. Does it make my work life easier? Definitely yes. If Resident X can handle the change, everyone else will be perfectly fine with it. It can mean the difference between a good day and a day where I'm trying to push water uphill for eight hours. I'm happer when those days were few and far between. And so are my residents.

Finally

I should have weekly access to my blog now. Sorry it's been so long since I've posted. Right after my last post, the library decided that it wasn't going to allow us to use Blogger any more. It's a social networking site, ya know. And all social networking sites are the devil, apparently.

In any event, I plan to post every Sunday. I realize I've lost what few readers I had, but I hope to lure a few of y'all back in once I get back to regular posting.

Sorry for the hiatus

This is the first chance I've had to get online at the library. I have not "gone the way of all flesh", it's just a lack of planning on my part.

We're hoping to get Internet service back at the house by the end of July. Then I'll get back to regular posting.

In the meantime, I'll work on some of my thoughts so that I can have something intelligent to post the next time I am able to get back here. Assuming it's before we can get the new ISP.

I will say that we now have a new DON (the fourth since I started working at this facility in February of 2008). It would be nice if she'd stay on for a couple of years instead of just a few months like the rest of them.

Loyalty, Compassion and a Good Constitution

In my mind, the three things that should be required for a CNA are loyalty, compassion, and a good constitution. If anyone can figure out a reliable way to test for these, let me know. Our work environments would improve greatly if everyone had these qualities.

I put loyalty first just because it's the most important to me. I don't mean loyal to your employer, I mean loyal to the residents. These folks live here year in and year out and just watch the help come and go and sometimes come back again. It must be hard for them to adjust to new people and personalities all the time. I have one resident who won't deal with new co-workers at all. They have dementia and seeing new faces puts them on the defensive. Now that I've been there for more than a year, while they don't know me, I think they recognize me. Most days they'll allow me to care for them and give them their medication. They'll smile and talk to me as best they can. If a new person tries to care for them, they get suspicious and refuse help, medication and anything else they can say "no" to.

Compassion is a no-brainer. No one wants to live in a Nursing Center. Sure, some of them become resigned to it, but none of them are really happy to be there. Being compassionate means comforting them and empathizing with them. This includes being kind even when they are angry, but being firm if you can't honor their requests. (I run into this a lot when a resident wants a pill that they don't have an order for. Sure, we have that pill in-house somewhere, but if they don't have an order for it, we can't give it.) It means offering alternatives when they can't have what they want. It means saying "What can I do for you?" instead of "What do you want?" when you enter their room. It means taking a moment after you've completed their care to see if there's anything else they need before rushing out the door. It means resisting the urge to put words in their mouths when they hesitate mid-sentence. The previously mentioned resident speaks in a word salad and gets angry when you try to correct them or fill in the blanks for them. I've learned to let them hunt for the word they want and try to figure out what they mean at the end of the sentence. Patience is a large part of compassion in this environment.

A good constitution is necessary because a lot of times we find ourselves working sick or injured. And we need to be willing to work, if possible, when we're ill or hurt. (Personally, my rule is that unless I'm vomiting, have diarrhea that can't be controlled with Immodium, or have a fever that can't be controlled with Tylenol, I'm working. And don't talk to me about spreading germs, we have gloves and masks and frankly, most of the time, we're contagious 24 hours before we even know we're sick, so we've already "shared the love" before we had to start taking Nyquil to sleep.) We need strong backs and strong hands because our residents need us to be their strength. We need to be able to smile and be kind even when our heads are pounding or our throats are sore. If I could infuse every cup of coffee or iced tea we drank with a +5 Constitution, I would.

Which brings me back to my initial question: How do we test for these qualities? Even if we had a test for them, would the people who had them even apply for the job? If a person doesn't have these qualities, can they be taught?

Seeing How the Other Half Lives

Well, after a week off, I'm back at it.

It was very interesting yesterday. When we have two Med Aides, we physically split the Nursing Center in half. They've had me working the same half since March 2. Guess where I was last night?

The other half.

I made it through relatively unscathed. I think the key was not getting frazzled and just working my way through the cart one resident at a time. I didn't get but one break, but then I never do when there's only two of us. And I got done with the last pass on time, which was a gift. Although when I woke up this morning I realized that I hadn't returned my eyedrops to their proper place. They're probably using my name as a swear word right about now.

All in all, it wasn't bad. It was nice seeing the residents that I don't get to talk to much when they have me insulated over on the other side. They seemed happy to see me for a change, too.

***

On another note, we may be losing our ISP as of May 31 which means posts may be sporadic since I'll have to post from the Library. Once we find a new provider and get them out here to set up their equipment, then I'll get back to regular posting.

On hiatus

I'm putting the blog on hiatus until May 27th. Really, I'm just trying to get through the next three days of work and then I'm on vacation. I plan on being rested and refreshed and ready to write when I get done.

Talk to you later.

Grandma Prison

Yes, I said it. But it's not original. I got it from an episode of The Brak Show:

http://en.wikipedia.org/wiki/The_Brak_Show

I don't remember which episode it is, but Zorak is threatened with having to go back to "Grandma Prison" if he doesn't do... something that I can't remember.

In any event, my son now teases me that I work in Grandma Prison.

And I wouldn't have thought any more about it except that yesterday, my charge nurse was telling everyone that a couple of residents were "trying to escape".

So what's the point of this post. It's about how we think about where we work and what we do. Do you think you work at "Grandma Prison"? Are you "just an ***wiper"? Or "just a pill pusher"?

Our job is hard. We do things that few people want to do or have time to do. We talk to people that few others can understand. (Word salad anyone?) Many times, we become family to these residents, even if their families come to visit them regularly. Their families can't be there to hold their heads while they're vomiting, but we can and do.

We don't work at "Grandma Prison". Yes, we are ***wipers and pill pushers, but we are more than the sum of our parts. We become a part of our residents lives that is at least as important as their families. Everytime we smile and listen to a resident, even if we can only guess at what they're saying, we make their lives better. We need to revise our way of thinking and be proud of what we do. Our residents know our value. We need to acknowledge it, too.

The Chocolate Pudding Incident and Other Tales...

"Miss?" (I get called "Miss" and "Ma'am" and occasionally "Sir" a lot. I also answer to "Hey You".)

"What can I do for you?" I yelled as I walked into the room.

"Well, can you help me with this?" they asked, plucking at their hospital gown.

It, and they, were covered in chocolate pudding.

And then they started laughing. Uproariously.

"I kept trying to rub at it and it just kept getting bigger and bigger." More laughing.

About fifteen minutes later, they were clean, dry, wearing a new hospital gown and had clean sheets on the bed.

"You know," I said, "we have a bathtub here. Next time you want to bathe in chocolate pudding, let us know and we'll fill it up for you."

They started laughing again.

***

"Can I help you?" I asked, preparing to get behind the resident's wheelchair and give them a push.

"Oh, just destroy me," they said, disgruntled.

"Destroy you?" I asked. "I don't get paid to do that. That's an extra charge."

"Oh..." they said. And then they started giggling.

***

"Can I give you this vitamin before you run off?" I asked, handing the resident a glass of water.

They laughed. "I can guarantee you one thing: I ain't gonna be runnin' nowhere."

ISP issues, yet again.

We've been having trouble with our ISP. Today it seems slightly better, but with more storms coming this week, I don't have a lot of hope for it to stay up.

I've got a couple posts I want to make and plan on getting at least one polished and up tomorrow.

First, you work in one...

...then you live in one.

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

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

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

Saving them from themselves

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

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

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

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

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

"I'm cool."

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

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

I got outed.

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

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

It wasn't even a couple months.

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

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

Pain is what they say it is.

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

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

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

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

Not Quite Recession-Proof (Negative Post Alert!)

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

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

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

Good Inservices v/s Bad Inservices

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

A good inservice should include:

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

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

War Wounds and Battle Scars

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

"I wish my arms were nice like yours."

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

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

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

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

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

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

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

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

They don't need to know EVERYTHING

We do like to hear ourselves talk, don't we? How many times in your life have you said something and then wished you could "unsay" it? How many times have you said something and then two days later it came back to you completely different than how you originally meant it?

As much as we may like to talk, we need to remember that the residents are not a receptacle for every bit of verbal garbage that we have. They don't need to know the following:

• Your sexual orientation.
• How many baby daddies you have.
• How you feel about the Nursing Center's administration.
• All your thoughts on God.
• Your personal problems.
• How you feel about the other residents.
• How you feel about your coworkers.

Seriously. If I told you how many times a resident has told me "So and So said such and such" and then proceeded tell me how upset they felt about it, you'd be amazed. I apologize frequently for the crazy stuff my coworkers say.

If you want to spout off to your coworkers, your friends or your family, knock yourself out. Don't lay it on the residents. They have enough to contend with already.

O/T Winter Storm in Spring

They had been talking about it for days. Frankly, I thought they were full of beans. There's no way we were going to get 6-12 inches of snow. It's been running about 70 degrees for days and the nights have been warm enough to leave the heaters off.

Shows you what I know.

Friday morning around four, it started thundering and lightning. Then a couple spits of rain. Then a couple spits of hail. Then it sounded like someone was throwing hundreds of golf balls at the house. This lasted a good five minutes. Now, I know hail. I have never experienced hail that lasted more than a minute or two. When it started to slow down, I looked outside. The ground was covered like it had snowed already.

Nothing but clouds and wind all day. Then, it started sleeting at about four in the afternoon. Then big snow flakes blowing sideways. We all made it home from work OK, though they did close the grocery store at eight instead of staying open all night as usual.

Thank goodness I didn't have to go to work on Saturday. The guys had to work at eleven. The wind was so strong, the snow was still blowing sideways. I don't know what our official number was, but it looked darn close to six inches of snow including the hail that was left over from the previous morning.

Today, the snow is half melted. Unfortunately, it looks like someone tried to rip all the leaves off the trees. Poor things, they're just shredded and the ground is littered with little pieces of green confetti.

It's supposed to be 70 tomorrow. I imagine the only remnants will be the mud and the leaf confetti by the time I get home from work tomorrow night.

When overwhelmed, pick a tree.

Let me confess to one of the Seven Deadly Sins: Hubris. I tend to think that I'm an above average worker. When I'm feeling less proud, I could point out all the things that I do wrong or could be doing better, but for the purpose of this blog entry, let's just assume that I really am as good as I think I am. (Ha!)

The past few weeks have been a challenge. I feel like no matter how much good I try to do, it's overshadowed by all the bad going on around me. I know that we're all stressed out over the changes coming down the pike. We're due for "State" to come in for our yearly review, which always causes stress in itself. We have a new Administrator and our DON is stretched to the breaking point. It wouldn't surprise me if I came on here in a month or two and announced that I was getting to know a new DON. We've lost some employees and haven't replaced them with new ones yet. The economy is bad and the sky is falling.

But, ultimately, the goal is to keep our residents as healthy and comfortable as possible. Sometimes you need to buck up and do your job despite the avalanche coming down around you. Somehow, I feel I'm the only one who sees this. The rest seem to just let themselves get buried.

The saying "...can't see the forest for the trees" has negative connotations. However, when the avalanche is rumbling toward you, sometimes focusing on a tree is what will get you through. Concentrating on the details and getting at least one thing done before starting the next will save us from being completely buried.

Today, I'm going to worry about the tree. Eventually, I'll make it through the entire forest. It just may take longer than I originally planned.

Finally, I can laugh.

I used to get in trouble for laughing. Apparently, if you're at work, you're not supposed to find anything funny. Now, granted, my laugh is loud and attracts attention but if something's funny, it's funny and I will laugh at it. Even when working at the C-store, I'd get the frowny face from my manager if I started laughing.

At the Nursing Center, I can laugh. Especially if I can get a resident to laugh along with me. Laughter is a good sound and the more smiles, the better.

Yesterday, one of the very confused ladies came over and sat next to us while we were eating supper. She lifted up the edge of the table cloth and tried to look under it.

I said to Aaron, "She's trying to look under your skirts," which scored a laugh from everyone at the table, including the resident and the kitchen staff who were cleaning up around us. This went on for a couple minutes, with the resident still goofing around and us making jokes.

I've never had a job where I've laughed as much as I have at this one.

"She's a great worker, when she comes to work."

The truth of the matter is that no matter how good you are when you're at work, if you only show up for 75% of your scheduled days, you're not a good employee.

We recently lost a CNA because, while she was great with the residents, she would just decide not to come to work for several days at a time. It's a shame, because the residents loved her and she even won Employee of the Month once.

Now, she's gone and I'm not sure if I'm happy or sad about it. If her replacement is slightly less wonderful, but shows up all the time, I think I'm willing to make that trade.

Interrupting the Grieving Process

When we suffer a loss, we grieve. That's how we work through it and get to the other side so we can keep going. Generally, this starts out with crying.

Most of us are uncomfortable with tears. Not our own, but other folk's. We can cry all we want, but if someone else is crying, we don't know what to do.

Enter Better Living Through Chemistry.

Why is it that our first reaction is to pass out an Ativan or Xanax when a resident is crying? Why can't we just let them cry? I'm not talking about crying that lasts for hours and hours. Then some chemical help is called for. But if a resident gets news that a relative has died, surely we can let them cry for a little bit. When I cry, I don't reach for a pill to help me stop. Most of the time I don't even reach for a beer. (I save that for when I'm angry. Just kidding. Sort of.)

We need to let them go through the whole grieving process, even the crying. Even if it makes us uncomfortable, a hand to hold will do as much or more than a pill and with less side effects. It's OK to cry. And it's OK to feel uncomfortable when someone else is crying. We don't need to interrupt the grieving process unless it's negatively affecting the residents health.

"It's all about love...

...and not about money." Rose by Buckcherry

OK, so that song has nothing whatsoever to do with being a CNA. But that line is the exact truth. The folks that get into this line of work for the money are many and few of them last long. You have to want to do it if you're going to stick with it for more than a couple of months. If money is your only motivation, you won't be happy being a CNA.

On the other hand, if you get a charge out of helping people, this is the job for you. If customer service of any kind rings your bell, you don't get more service oriented than being a Nursing Assistant. If knowing you've comforted someone or lent a sympathetic ear makes you happy, come on over. We can always use good people who don't mind taking a little crap in exchange for the joy you feel when you've helped someone feel better.

Melodrama

I walked into a resident's room the other night to give them their medicine.

"Hi, Miss Jane. I've got some medicine for you," I said.

"Meet Miss Jones," she said. "The woman..." Pregnant pause. "...without a coat."

This is probably a location joke, but I nearly burst out laughing. You would have thought that she was missing a limb. I did try to help her look for it. And we notified Housekeeping to be on the lookout for it, too.

On the other hand, our resident's have already lost everything: Their homes, their independence, their health. A coat seems like a small thing. I'd just go buy a new one. To them, it's a metaphor for what their life has become: a series of small losses that have left them with nothing worth having.

We can make all the noise we want about making them feel needed and wanted and useful, but the bottom line is we can never replace what they had, however little it may have been to begin with. It sounded like melodrama, but she's really just in mourning.

No one ever thinks they'll end up in a Nursing Center

Truly. Most people figure that one day they'll just drop dead (hopefully later rather than sooner). Yet, as my instructor pointed out to me, we're all just a car accident away from lying in one of those beds ourselves.

The point of this blog post? To hell with: "would you want your momma treated that way?" That could be you in that bed. Treat them all the way you want to be treated when it's your turn. If you're lucky, good Karma will outweigh bad when it comes time to pay the Piper.

Can't we all just get along?

Seriously.

Our first responsibility is always to take care of the residents. But our second responsibility should be to take care of each other. Most of us are not working in a vacuum. We rely on our coworkers to show up and work alongside us so our residents are as comfortable as they can be. There's no benefit in deliberately doing things that make the job harder for the next shift. Hell, on any given day, there are things that we want to do that don't get done to make the next shift easier. Going out of our way to make the next shift harder is stupid and harmful to the residents.

What a dumb thing to be blogging about. This sounds like the kind of crap that goes on in high school. Yet, it's not. In fact, the people involved are all over 30 years old. If that doesn't frighten you, it should. It frightens me to realize that we never mature mentally beyond age 15.

My goal is always to leave work with everything and everyone in the same or better condition than when I came on shift. I don't want the folks on the next shift to groan when they come in and see me. I want them to know that they can rely on me to do my best. And when I don't make my goal, I apologize. I also sometimes offer to help them set things to rights so that they won't be completely miserable and overwhelmed.

If we take care of each other, the residents will also be better taken care of and that can do nothing but good for us as a Nursing Center.

Remembering who we work for.

When I get frustrated, which is often, I usually get zapped in the behind by whomever is in charge of reminding me why I'm here. God, Goddess, the One, the Source, the Divine...whatever.

We reduced staff recently which means my workload as a medication aide increased by 50%. On the bright side, this should net us more CNA's to work the floor. On the not-so-bright side, this means that someone is always getting their medication later than they should. As I was lamenting this one day, I had a resident thank me for taking care of them. I didn't do anything special, just pulled them up in bed and adjusted their pillows. Still, scoring a "thank you" and the glow of pride that goes along with it, is worth the guilt I feel at being late.

Management thinks they know what I do, but they don't, really. Frankly, I don't work for them anyway. My bosses are the residents. My one year anniversary was yesterday. When I get my review, it will be from management, not from my real bosses. The "thank yous" are worth more than any monetary reward or hollow "atta girl" I might get from them anyway.

Better Living Through Chemistry...

...or chemical restraint?

Using chemical restraints (giving medication to a resident for the sole purpose of making them easier to handle) is illegal. However, there is a very fine line between treating a resident and using a chemical restraint.

Case in point: Resident A is screaming. I mean SCREAMING. Not because they are in pain, but because they are unhappy about their meal choices and no one is able to go purchase a meal from Sonic for them, including the resident's family members. The hall has about 30 residents on it and every one of them is getting more and more upset as this goes on for more than an hour. Nothing the kitchen can make is good enough and all the cajoling in the world is not making the situation better.

Fine.

Said resident is due for a routine pain pill. They also have a PRN order for a "relaxing pill". This is a new order from the doctor and the resident has not taken one yet. The "relaxing pill" is given along with the resident's routine meds which include the pain pill. Within thirty minutes, the resident is quiet. When I reach the dining room to finish passing the meds for the five o'clock, the resident is sitting at one of the tables, chatting with the other residents. This is not normal behavior for this resident. Usually, they eat in their room. The resident eats about half their meal, all the while being pleasant. The next thing I hear is singing. "I found my thrill...on blueberry hill..." After supper, instead of going right back to their room, the resident sits in the TV room for about an hour and then politely asks to be taken to their room.

Wow.

So, was this better living through chemistry or chemical restraint? The resident wasn't given anything that was not prescribed for them, but it was given for the purpose of quieting them down. The other twenty-nine resident's on the hall were certainly thankful for it. All of the nursing staff was grateful as well. This was likely the nicest evening this resident has spent in a long while, so I imagine they were happy as well. As with most things ethical, the line is so fine, it's often nearly invisible.

Let's talk about sex...

...and other sins of the flesh like smoking and drinking. All legal, but possibly immoral depending on your personal beliefs.

I have always maintained that if a resident wants to smoke, drink and/or engage in consentual sex, they should have the freedom to do it. However, if they have given power of attorney to a relative, the relative gets to make these decisions, not the resident.

We can argue back and forth all day about whether the resident is in their right mind or not, whether it could kill them or not and whether it's moral or not. The bottom line is this: if it was you, wouldn't you want the freedom to do what you wanted as long as it wasn't hurting anyone else?

ISP trouble

Been having 'net trouble for most of the week. I'm hoping to get back on track with posting soon.

Good Advice

Last night, one of my residents kept asking if I needed any help. I was passing meds, so there wasn't really anything they could help me with. Sometimes, if we're working the floor, we can find something for the residents to do: fold towels or pillowcases, push the linen bin from room to room, etc.

Later that night, the resident was my last med pass. I went to their room and they asked if I had time to visit. So, I sat down with them and scored an excellent back rub and some advice.

"Now, when you go home tonight, go to bed. Don't do all that stuff you usually do. Let them do for themselves. They work, but you work, too. In fact, you give them a little back rub and then have them give you one, too."

This from a resident that has severe dementia and occasionally violent behaviors. Good advice is good advice regardless of the source.

O/T Patrick's 20 years old today.

And just how did that happen? I don't feel twenty years older, but I guess I am, too. Looking forward, it seems like a long time. Looking backward, it seems ridiculously short.

New topic: Andrew Haden went back to Iraq after a 15 day leave. Please send good thoughts to him. He should be home in June or July.

A little good news

Currently, our facility doesn't offer medical insurance. It's a "discount plan" that doesn't pay for major medical in any way. I don't have it. Frankly, if I'm going to pay for "insurance", I want to be covered if I have to have surgery or something else expensive.

Yesterday we found out that we may be able to qualify for insurance through some state run deal. If we qualify, it will be a plan run by Blue Cross/Blue Shield. We're supposed to know for sure by April.

I hope this goes through. If it doesn't, then I'll still be covered by Brad's insurance eventually. After he's been in the Union for a year, he can add me to the plan. Still, sooner is always better than later.

Nice to get some hope for a change.

Birthdays and Birthrights

So, a year ago today, I stepped into the classroom for my first day of CNA class. I've learned a whole lot in the last year and I still have a whole, whole lot left to learn. There's more to this than picking out permed hair and wiping bottoms.

Today is also my mom's birthday. She would have been 61.

Mom was an LPN. I remember seeing her in her white nursing uniform. I don't remember if she still had to wear a nurses cap back then. I can't imagine having to run around and keep a hat on my head. Most days I'm glad to have my hair left when shift is over.

I used to have a picture of my Grandma, who was an RN, when she graduated from Loyola University in Chicago. Like most things I used to have, it's been lost over the years. My sister is "the keeper". For me, it's a good day when I can find my ass with both hands.

Birthright is defined as any right, privilege, or possession to which a person is entitled by birth, such as an estate descendible by law to an heir, or civil liberty under a free constitution; especially the rights or inheritance of the first born. I don't know that you can say that being in nursing is my birthright, but it seems like that's where I belong. Even on a bad day, something always makes me smile. The joy I get when someone is comforted by my actions is worth everything to me. The paychecks I receive are important, but not as important as going home knowing someone feels better because I was there that day.

Our lives are bigger gifts than they appear to be. Not just to ourselves, but to everyone around us. Even the lives that are cut short or seem to have no good purpose are gifts. It's hard sometimes to remember that, but the truth is the truth regardless of how strange it sounds.

Just another crazy night

I don't know what was going on last night, but no one was acting normal. I had people who don't normally want to go to bed, ask to be put to bed. I had residents in loads of pain for no apparent reason and I couldn't get past one room in less than ten minutes while passing meds. I even ended up helping on the floor a little because the call lights were bonkers.

I wonder if they were drowning in the staff's stress last night. It was pretty high because the schedule was changed and folks weren't told like they should have been. Unfortunately, when we're upset, even if we don't say anything, the residents can still tell we're not happy. We need to do a better job of leaving our baggage at the door and picking it back up on the way out.

Working with a Migraine.

Yesterday was one of the few times I've wondered if I should just call in sick. My head was on fire, my stomach was upset and I was DIZZY. I couldn't even eat. But I went to work because I know a migraine isn't contagious and maybe it would let up as the day went on.

It did. A little. But then work was rough. Only two med aides when we're used to having three. I ended up doing one long med pass from 1545 to 2200. No breaks, no supper. I made it through the day on a half a piece of dry toast, half a can of diet Pepsi, thirty-two ounces of Gatorade and four graham crackers. I did eat some Mexican appetizer thing-y's with salsa and sour cream after work, so I probably had enough calories after the fact.

I'm better today and though I did make an error, it wasn't resident affecting. We just had to destroy a narcotic that I punched in error. I started crying anyway, just because I was stretched so thin. But the nurses teased me back to center and I made it through the night.

A person needs a strong constitution and thick skin to do this job. Maybe that's why so many people drop out of this career to do "easier" work.

"I don't know if I can sleep in there."

We had a resident pass away in their room recently. For the first couple nights after the death, the resident's roommate was fine. Then they told me they were worried about sleeping in the room.

I agreed with them that it was a little strange knowing that someone had died in their room. I didn't really know what else to do besides sympathize. Honestly, I found it kind of odd since all of our residents are Christians and I didn't think they worried about these kinds of things. I mean, don't they believe that the person is "with Jesus" and therefore can't bother them?

Frankly, we should have moved the sick resident to the Hospice Room when we knew they were going to pass. That would have alleviated the problem altogether. Still, I wonder what I could have said to make the roommate feel better.

O/T Four Dog Night

Brad is out of town for his birthday. Our bedroom is on the north side of the house. Now, we've had a really mild winter so far. A couple cold days followed by four or five warm days. (This is Oklahoma, though, so what I call winter doesn't generally start until January and it ends on March first. Everything else is spring or fall until it's summer which lasts from April through most of October.)

Anyway, the wind switched yesterday and by the time I got home, the wind chill was 11 and it felt like it was about 45 degrees in my bedroom, even with the heater on. So, I took ALL the blankets (6 total) and piled them on me. That's about when the canines started wandering in. By the time I woke up this morning, I was toasty and had three boxers and a doolah on the bed with me. They must have liked it, because after the morning potty break, they all went back to the bed.

From the weather reports, it looks like winter is finally officially here. No more 65 degree days to spoil us. We may even get an ice storm on Monday depending on how feisty Mother Nature is feeling. And then some rain later in the week. We need the precipitation since it's been pretty dry this year. I'm sure the farmers growing winter wheat are stressing about the lack of moisture. Hopefully we'll get enough rain this week to give their crops a boost.

Time for a time out.

We've had an influx of residents recently. One of them calls out for their family and cries at the drop of a hat. And they won't always take the dozen pills or so that they've been prescribed three times a day, plus PRN's. It doesn't matter to them that the pills might make them feel calmer and more comfortable, they just say no as a matter of course.

This resident is at the end of my med pass on that hall. During my entire pass, I could hear them "Joe... Donna...Joe...Joe...Donna." I'm surprised that they're not hoarse by the end of the day. My brain was grated raw by the time I got to their room. I went looking for my charge nurse so I could add some Tylenol to their bedtime cocktail. When I couldn't find the charge, I went outside and took a break. It's one thing to get frustrated with my coworkers. It's another thing to get frustrated with my residents.

When I went back in and found my charge nurse and got permission for the Tylenol, I felt calmer and my resident took their meds with almost no argument. I guarantee it wouldn't have gone so smoothly if I'd have gone in with raw nerves standing out all over. I'm glad I put myself in time out first.

Paying it forward.

It doesn't matter what your job is, where you live or what your name is, ultimately every action you take affects your future and ripples out to the futures of those around you.

When we're working with the residents, our attitudes need to be kind, respectful and helpful. Not only because they deserve it. (After all, they've lost everything, all they have is our kindness, respect and help.) But because we're all just a car crash away from laying in one of those beds ourselves.

From Christianity:
"Do onto others as you would wish them do onto you."

From the Baha'i Faith:
"Ascribe not to any soul that which thou wouldst not have ascribed to thee, and say not that which thou doest not." "Blessed is he who preferreth his brother before himself." Baha'u'llah

From Buddhism:
Hurt not others in ways that you yourself would find hurtful." Udana-Varga 5:18

From Hinduism:
This is the sum of duty: do not do to others what would cause pain if done to you. Mahabharata 5:1517

From Islam:
None of you [truly] believes until he wishes for his brother what he wishes for himself." Number 13 of Imam "Al-Nawawi's Forty Hadiths."

From Judaism:
"What is hateful to you, do not to your fellow man. This is the law: all the rest is commentary." Talmud, Shabbat 31a.

From Native American Spirituality:
"All things are our relatives; what we do to everything, we do to ourselves. All is really One." Black Elk

From Wicca:
"An it harm no one, do what thou wilt"

There's a reason that all the world's religions have a "Golden Rule". (There's obviously more religions than listed here. I pulled these from www.religioustolerance.org if you want to read more.) It's because we're all just paying it forward.

"We must all hang together...

...or most assuredly we shall all hang separately." Ben Franklin

Teamwork is crucial in a Nursing Center. If there's strife among the crew, it adversely affects the resident's. They don't get the care they deserve and they're upset because we're upset.

We should always make the residents number one. If we remember that our wants are secondary, then we'll keep our frustrations to ourselves and do our jobs to the best of our abilities and beyond. The residents deserve no less.

On the other hand, if we choose to fight against one another and management, we may find ourselves out of a job. Or worse, trying to work with frustrated residents who are fighting against us. Either way, life is more difficult all around.

Personally, I prefer hanging with a group to being hung out to dry.

There's more to it than that.

So, it's not just the full moon and the wild weather that makes people more demented than usual. Last night we had several folks request their "nerve pills". We had folks refusing their meds that they normally take. I had one woman standing out in the hallway in her brassiere. I don't know what the deal was, but I was glad to get home.

Senior citizens are a lot like children under the age of six. They are more sensitive to the world around them than I am. I'm so busy thinking of what I have to do next and next and next that I don't sense the little changes in atmosphere that they do. And I don't just mean weather and the position of the planets. Even the combination of staff working during a shift can make a difference in the resident's moods. If the crew is working well together, it seems to keep the residents calm and more pain free.

I imagine there are other factors that contribute to a wild night. It's a bummer that we can't just look up the weather and moon phase for an indication of what the shift will be like.

Yeah, it really can happen that fast.

Yesterday at supper time we sent a resident to the ER for ridiculously high blood sugar. I had given the resident their normal evening medications at around five pm. This resident suffers from dementia, so they seemed "normal" to me. For a change, they didn't try to chew their pills and I considered this a good thing.

When we got the call from the hospital, the resident "may have had a heart attack and a stroke" and were being admitted. Yeah, it really can happen that fast and without any real warning. The high blood sugar was telling us something was out of whack, but no one thought it was pointing to a stroke and heart-attack.

The resident is in the "old-old" age group and has not been with us for very long. Assuming that until they moved into the facility, they had been living a relatively healthy life (and I would say this is the case based on the relatively small amount of medication they are on), this is the way to go. When you start to go downhill, take the extra slippery slope so you don't spend years and years being miserable before you cross over.

It's not about YOU.

Reasons NOT to become a CNA

• You want to make a lot of money.
• You think the world should revolve around your wants and needs.
• You need constant reassurance that you're "the best".
• You expect to get your full breaks and lunches when you want them.
• You think every management decision should be to your advantage.

Being a CNA is about the residents. It's not about you. If you're not willing to put the residents above yourself, please go find another job where you can be the center of attention. If you can find one.

This 'n that

Well, I've already managed to upset one of my coworkers because of my Frankenstein Finger. I asked to be left on the med cart instead of working the floor. In the 10 months I've been there, I've never asked for a specific assignment. I've always worked wherever they've put me, sometimes switching multiple times or floating during my shift. Yet, somehow I'm the bad guy and I was asked if I went to the doctor. If they ask me again, I'm just going to rip off the bandage and show it to them. I ended up helping lift some of the resident's anyway and had to put a third layer of bandages on so I wouldn't become a walking bio hazard.

***

On another front, I was given information and asked specifically to keep it quiet. So, I did. Two days ago, another aide comes up to me and said, "I heard so and so is changing shifts."

"Really?" I asked, playing dumb.

"Yep. That's what JoJo the idiot circus boy told me."

"Well, we need better help on that shift anyway. It might be a good thing." I said.

If it's a secret, how come people who shouldn't know about it are filling me in?

***

Resident comment:

"Well, with those ear bobs he wears, it's not a girlfriend you should be looking for, it's a boyfriend."

"Really?" (I say "really?" a whole, whole lot. It allows me to agree to disagree without offending anyone.)

What's best

Shouldn't the goal always be what's best for the resident?

One of our aide's yesterday suggested to a resident's daughter that a Wound Center in the city might be able to help her parent. But she told the daughter not to say anything to the management at our Nursing Center because she "might get in trouble".

I'd like to think that we're above all that. The primary goal should be to get the resident's well that can get well and comfort the ones that can't.

This wasn't a case where the aide told the daughter to take her parent away and never bring them back. Just a suggestion on where they could go for more specific help for their particular problem.

I am starting to think some of my co-workers are paranoid. I speak my mind. If that gets me fired, so be it.

Working injured

In the epitome of stupidity, I slammed the middle finger on my right hand in the car door last night. I'm going to lose the nail and every time I move, the darn thing starts to bleed again.

So, I'll be working injured for a while.

I'm hoping to be scheduled on the med cart until I'm healed. If so, I'll be fine, but slow. If not, I've got some negotiating to do.

Pie in the Sky

At full capacity, I think our Nursing Center can hold around ninety residents. Two days ago, I actually heard this come out of our DON's mouth.

"I'd like to have 4 CNA's on 3, 4 CNA's on 4, and 2 CNA's on 2, 3 CMA's and 3 Nurses per shift."

Wow. We'd have the happiest resident's in the state with that amount of help. And no excuses about why something didn't get done or someone didn't get the care they needed or wanted.

If that's the goal, I'm for it. The real issue is attracting employees. What we need to do, is find out when career day is at the high schools and start talking up our jobs. Surely there are kids out there who want to do the kind of work we do. Granted, it's not a job that will make you rich, but it does give you a lot of joy and personal satisfaction. It's all about what's important to you.

Well, there's the pie in the sky. I wonder if we'll ever get a taste of it.