Patients that Changed My Life: Carol

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy purposes, I won’t use real names, but I want to tell you their stories.

To read about previous patients, click here.

In one of my first ever nursing jobs, I worked in a facility specifically for Alzheimer’s and Dementia. I didn’t really know what to expect, but I found that I loved working with them. They kept me guessing, and usually laughing. We had this one lady, who I will call Carol. She was active, even though she was declining rapidly. She used a merry-walker, which kept her safe when she would suddenly get tired and need to sit down.

She had almost no short term memory. You could have a conversation with her and seconds later, she wouldn’t remember it.

That doesn’t mean that she didn’t remember anything.

She had an issue with me almost immediately. No matter what I did, she got angry, and she would scream at me. It wasn’t that unusual, since she had a temper, but she did seem to single me out more often than not. I had no idea why until a few months into the job when she said something that surprised me.

“Get off my husband!”

I wasn’t sure how to respond, but I let her know that I wasn’t on her husband. Over time, she kept making comments that made me believe that her husband must have cheated on her with an Asian woman. Comments like:

“Get out of my house!”

“Get out of my husband!”

“They’re my kids, not yours!”

“Tell me it didn’t mean anything and you didn’t enjoy it.”

Most people don’t really think about it, but it’s the emotionally traumatic events that seem to stay with Alzheimer’s patients. They may not remember that they just ate, but they remember how people made them feel. Those memories stick with them longer than anything else, even if they don’t even know my name.

Just because they’re confused, it doesn’t mean they aren’t there, and that they don’t notice what’s going on around them. 

Hospice

After working for years in long-term nursing, I’ve become very familiar with hospice. In fact, my first nursing job was on the hospice floor of a facility for Alzheimer’s/Dementia. Not all of our patients were on hospice, but there were quite a few that were. I loved the hospice we worked with. They were involved, and they always worked with the nurses on the floor to make sure that we all agreed on the plan of care.

Often, we had a patient who would go on hospice and would be diagnosed with ‘failure to thrive,’ especially if they suddenly lost weight, or wouldn’t eat.

Here’s the thing though, they didn’t stay on hospice until they died. Often, the doubled effort between the facility and the hospice caused the patient to have increased care and as a result of that, their health usually improved. As a floor nurse, I let the hospice nurse know whenever I had concerns, or if I thought something would be more beneficial. Increasing their protein shakes, or switching them to finger foods.

More often than not, after a few months on hospice, the patient would start to improve to the point that they no longer qualified, and hospice would discharge them into our care.

For me, hospice wasn’t an end of life kind of thing. Of course, it’s for those who have a poor prognosis, or who have been given a short time to live, but that doesn’t mean that they will die within weeks of going onto hospice. Hospice was an assist for the patient and the family so that they could cope, and, most importantly, to make sure that they were comfortable.

Unfortunately, I’ve discovered that my first experience with hospice was the exception rather than the rule. I’ve worked with multiple other hospices since then, and it often feels like the program is created to transition into death. Too often, they’re cut off everything they might need to extend their life because they’re just going to be ‘comfortable.’ All blood pressure, thyroid, or even heart medications are discontinued. They’re cut off because those medications aren’t necessary if they’re going to die. I’ve even seen hospice nurses hurry the process because they want to go home for the night.

Hospice was create for the patient and family to have support. So that they’re not alone in the experience. I’ve been there, and it can be scary, especially when you don’t know what to expect. But in the rush to help with death, I fear that too often they forget to allow life.

Sleep Deprived

Earlier this week, I mentioned that things had gotten a little crazy.

One of those things that got me all out-of-wack was my work schedule. I’m a nurse, which means that I work 12-hour shifts, three days a week. Plus, I live about forty minutes away from where I work, so added to arriving early to read charts and prepare myself for my shift, and finishing my shift at the end of the day, my shifts end up being close to fifteen hours.

Before working at my current job, I’ve worked night shifts, mostly because it’s hard for a nurse to start a new job and get a day shift. People like working days more than nights, which I guess makes sense. I’ve never had an issue with working nights, mostly because I hate mornings.

Waking up early in the morning makes me want to cry. Actually, it has made me cry on multiple occasions.

I love working night shift because it lets me live on less sleep. I don’t know how it works, but I can survive on five hours of sleep when I work night shift. I have to have at least seven hours of sleep when I work day shift. I don’t know why, but it just works that way.

When I started my current job, I let my boss know that I wanted to work nights. He was okay with that, except he wanted me to get to know the doctors, which mean that the last eight months I’ve been working what is called ‘mixed shifts.’ Basically, I work two months of night shift and then a month of day before doing it all over again.

February was my month of days.

It’s interesting how sleep deprived healthcare workers really are. We work long hours. When there’s not enough people, we pick up shifts. We work overtime and we work weekends and holidays. If we have something during that day or that night, then we just go without sleep.

It’s almost natural for me to go without sleep, at least until my body gets mad at me and forces me to collapse.

But that doesn’t happen… often.

When I was in junior high, my sister did a science fair project where she had people go 24 hours without food and then 24 hours without sleep and then take a math test and see where they failed. Every single person required sleep over food. Every single person except for the nurse. She did much better, even while sleep deprived.

I don’t know how it works, or where we learn it, but we know how to do our jobs when we’re half asleep.

I’m proud to be part of that profession. I’m proud to be able to repress my own needs to be able to care of my patients’ needs. 

Communicating with the Doctor

As many of you know, about six months ago, I made a transition in my career. I’ve loved geriatrics, but I started to feel like I needed to try new things, and push myself as a nurse. It’s been quite a transition, and I’m pleased to say that I’m starting to feel like I’ve got my own pace now, and things are great.

What’s been most fascinating is the transition from thinking like a long-term nurse to thinking like a hospital nurse. There’s still a few habits that I need to drop, but I’m definitely doing better.

One of the biggest adjustments has been my relationship with doctors.

In skilled nursing, your patients are fairly stable. Even those who are on the TCU or rehab side of things, they aren’t critical. You’re not going to be doing blood draws on them every day, and you aren’t going to be monitoring for a catastrophe. You’re really in the mindset of reporting any abnormalities. Along the same lines, most of the patients in a skilled facility are going to be the patients of the same doctor. One who usually has several other jobs, which tend to take priority. The biggest decision a nurse can make is:

Is this worth bothering a doctor for?

Usually, the answer is no. Especially when you’re working night shift. Even then, I’ve worked in enough facilities that I’ve had multiple doctors give us the instructions that anything he needs to be contacted about should be given to him in bulk. A patient wants eye drops? Hopefully you can wait until the doctor comes in… in three or four days. Patient’s weight fluctuating? Well, the doctor will be in on Wednesday. Hopefully they don’t lose too much more. We’ve had doctors request that we don’t call them for anything, except an emergency, and even when a patient dies, half of the time, we can’t get a hold of their doctor.

In the hospital, that’s not how things work. You’re always communicating with the doctor. If you’re wondering if you should report something to the doctor, you’d better stop wondering and just report it. Any small changes could be an indication of something bigger. Suddenly, I have doctors actually asking me about a patient, asking their latest labs, their vitals, how much they ate, things that they need to know to make sure the patient can heal enough to get back home.

Patients that Changed My Life: Donna

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy purposes, I won’t use real names, but I want to tell you their stories.

To read about previous patients, click here.

This patient was back before I became a nurse, when I was a CNA working in an assisted living. Assisted livings aren’t nursing homes, they’re mostly for people who need a little bit of assistance but can mostly survive on their own. As patients grow weaker, or sicker, they move to nursing homes.

I didn’t really understand the nuances or differences. In an Assisted Living, you’re supposed to encourage them to be independent for as long as possible. One of my patients, Donna, had early onset Parkinson’s, and she had a difficult time eating. For those of you who work in the medical field, and especially in long care, you know that we have all sorts of tools to help people like Donna. There’s the weighted silverware, which makes it so that the tremors are more offset, there’s the lip plates, which are almost like bowls, so that you don’t have to scoop the food, you can push it against the lip, and there’s nosey cups, which makes it so you don’t have to tip the cup back so far. There’s obviously much more than that, but those are the basics that I’ve seen used.

Now Donna had been working with different therapies, and she had weighted silverware and a lip plates, but even with that, she would spill food all over the place because of her tremors. She sat at a table with three other women, and I noticed that after a while, she stopped eating. She was so embarrassed by the fact that she made a mess that she refused to eat.

I served them their food every day, and we all noticed as she became more frail and weak. Finally, one of her tablemates asked me if I would be willing to feed her. Of course, I said yes, and I sat down with her, and she was able to eat almost half of her meal, which was more than she’d eaten in weeks. 

Later that week, I heard one of the other CNAs talking about it, and how Donna was now dependent on someone to feed her, and that if I hadn’t done it the first time, she would have done it on her own.

It kind of broke my heart to hear that. In a therapy standpoint, and looking back at it, yes, she probably would have kept trying at least a little more, but the fact was that she would wait until the dining room was cleared to even try. And by that point, the CNAs were eager to clean up so they could get on with their next chores. She always felt rushed, and she was so embarrassed that she put aside her own health, her own needs so that she wouldn’t annoy the people around her.

I started bringing snacks to her, little things that she could eat without using silverware. Now I know that they’re called finger foods, and I worked in a facility that actually had that as an option for those who had a hard time using silverware. Unfortunately, I haven’t seen it in any other facility that I’ve worked in. It’s an inconvenience for the kitchen to prepare a meal purely of finger foods, even if it makes it so that the patient is able to eat better.

It’s still hard for me to see patients who struggle to eat, or healthcare providers who are so busy looking at the bottom line or the health side of things to realize when dignity is being compromised.

Afraid of the Dark

 I love working night shift. A lot of people think that it’s because there’s less work to do, which might be true, but it’s more that there’s a different kind of work. A lot more of the behind the scenes, checking orders, etc to help day shift out.

I’ve worked day shift too, and I do enjoy the bustle and the busy. The thing that I hate is the hours. If I could get the busy of dayshift, but at night, I would be perfectly happy. But I don’t think my body is equipped for day shift. Waking up that early in the morning makes me want to cry sometimes. I’d rather stay up late than wake up early, and I don’t think that will ever change.

Working night shift also comes with a whole different set of situations. Night shift is obviously dark, since most of the lights are dimmed so the patients can sleep. It’s also quiet for the same reason. We want to let the patients sleep so that they can recover and heal. The other part is that it’s much more empty. You don’t have anyone in the kitchen, all of the activities and therapy people are gone for the day, and administration doesn’t work at night. It’s just the bare bones, enough to get through to the next shift. At least, that’s how it is in a skilled nursing facility.

What still amazes me is how many nurses and CNAs I’ve worked with over the years who were afraid of the dark. They would work night shift, but they were still terrified of the dark. They would jump at every sound, and they would spend their time scaring themselves while at work.

A few years ago, I was walking a patient up and down the hallway when she couldn’t sleep. After a few laps, she leaned in closer and asked, “Do you still hear the voices?”

I’m sure my eyes grew big, and I had no idea what she was talking about. Turns out, she’d gotten me confused with another nurse, who was afraid of the dark, and afraid to work alone in the hallway the patient was on because she would ‘hear voices.’ For me, the worst part of the story was that she told the patients, who had to live and sleep on that hallway, that she found it creepy and heard voices.

I had a CNA that I worked with who would close all of the windows. She was terrified people would be peeking in while we worked.

Any of you afraid of the dark, or worked with someone who was? Did it make it hard for you to work nightshift?

Patients That Changed My Life: Jimmy

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy purposes, I won't use real names, but I want to tell you their stories.

To read about previous patients, click here

In one of my first jobs as a nurse, I had a patient whose name was Jimmy. He was an active guy, and because of his dementia, he wasn’t able to sit still. He would pace the hallways for hours, and even during meals, he couldn’t sit down long enough to eat. The more stimuli he had, the more agitated he would get.

I think one of the reasons why I connected with Jimmy was because he reminded me of my dad. He was obviously a hard worker, and he usually thought that he was our supervisor. He would come up to the nurses’s station, go through the clipboard and then nod his head and tell us to keep up the good work. He loved it when we asked him for help or advice.

One of the things that I realized about Jimmy was that he did really well with personal, one on one interaction. He was definitely confused, and he didn’t make much sense when he talked, but he craved the human interaction, and not just being in a room full of people. He needed to make a connection.

I started saving his meals at dinner, and put it in the fridge in the kitchen. Then, after everyone was asleep, I would take him in the dining room, heat up his food, and the two of us would sit and talk. While he had the human interaction, he was able to sit. He was able to be distracted enough to relax, and he was able to eat something.

Even after he lost his memory and his home, he still was Jimmy. He never lost his identity, no matter what the disease did to him. Yes, there were moments when his personality would change, but as I got to know him over time, I realized that he was still the man he was his whole life. He was a supervisor, he was a father, and he was a friend.

Geriatrics and Poop

Right now, I'm still transitioning to working at a hospital instead of working in a skilled nursing facility. I'm on a Med-Surg floor, and I really like the opportunity to learn new things and use a different set of skills that I didn't need to use while in Skilled Nursing. It's busy, but a completely different busy than what I'm used to. There is one comment I've heard though, while working on my floor that makes me laugh.

Most people here assume that working with Med-Surg means that you work with poop. Everyone else has a specific purpose, whether it's the women's center, or ICU or even the cardiac floor. Med-Surg is where the patients go that don't fit in a neat little compartment. Which means we get a lot of the elderly, and a lot of those who can't take care of themselves.

However, when it comes to poop, I've got to say that Skilled Nursing definitely has a distinctive edge. When all of your patients are incontinent, and when all of your patients need assistance to the toilet, or can't get out of bed, all you do is clean up poop. It's something that I've just become accustomed to. In every facility I worked in, we had a set schedule, and when someone hasn't had a BM for a specific number of days, we give them something so they do. My first job, we had a poop board, and all of the CNAs had to update it at the end of their shift. I still remember my co-worker yelling at the CNAs to fill out the 'poops'. I worked in a facility where we started giving stool softeners after one day without a BM. By day 3, we were giving enemas.

In the hospital, the patient isn't in the building long enough to really worry about it. If they report that they haven't had a BM for several days, we can help them, but I've noticed it isn't as big of a priority as it is in a nursing home. And yes, there are incontinent patients, but the ratios are much lower.

As nurses, I think we should just come to expect to work with poop. It's a part of life, and we're the crazy ones who obsess over it.

Politics In Nursing

Back when I was a young idealist, I decided I was going to be a nurse. I was going to go and change people's lives, take care of them and just be the kind of nurse that makes everyone feel better. Unfortunately, reality doesn't always mirror our expectations. When I first became a nurse, I had the best job ever. All of our patients were private pay, which meant we had a very low nurse/patient ratio, as well as enough staff to actually take care of the patients.

Then hubby and I moved, and I found out that my dream job was the exception, not the rule. Since then, I've worked skilled nursing where all their patients are Medicaid or Medicare patients. Every building scrapes and begs for enough patients to break even. I didn't even realize how much the patient population affected the pay rate of the building until I took a management position and saw the behind the scenes.

The behind the scenes is what really made me wish I'd chosen a different career.

There is so much politics involved in nursing. There's trying to convince the hospital's social workers or case managers to send the patients to you, and not to the other facilities. There's the importance of the documentation because if one nurse or one CNA charts something incorrectly, it can cost the building hundreds of dollars. Maybe even thousands. And if all your nurses and CNAs document incorrectly, you can lose hundreds of thousands. Then there's the politics of home health and hospices coming and trying to get you to discharge your patients to them. In the area I'm in right now, I'm astounded by how many home health companies there are. For as rural an area that we are, there always seems to be more and more popping up.

Oh, and while we're talking about money and trying to get patients, there's also the push toward not even needing skilled nursing. When I was management at an assisted living, we started taking more and more patients that should have gone to a skilled. We found ways to get nurses in the building, whether through home health or through myself being on call 24/7. We just needed the patients in the building. There were times when I seriously questioned whether a patient was appropriate for assisted living, but there was always a loophole. Yes, they can't transfer themselves, but home health will shower them for us. Yes, they have a tube feeding, but that's during the day, and I was in the building anyway, right?

Now that I work in the hospital, I find that it's exactly the same. It's different, obviously. The way we're funded is different. The way that we get patients is different, but the idea is the same. Money controls the nurse to patient ratio. Money controls how many CNAs are on the floor. We have to do extra charting so that we can get funded by the insurances, but in doing the extra charting, we don't have time to actually be in with the patients as much as we'd like.

I hated the politics when I was in management. I almost felt like we'd forgotten the patients half of the time while we were trying to figure out how to cut corners to keep from spending so much money. It's an unfortunate reality, and I know that every business, and every field has the same problem. We can't function without the politics.

Why I Like Working With Alzheimer's Dementia Patients

When I first decided I wanted to be a nurse, I knew I was going to be a geriatric nurse. I knew that was where I was meant to be. My first job as a caregiver was in an assisted living that was specifically for Alzheimer's and Dementia patients. It was my first time dealing with those who were confused, and at first, I didn't know what I was doing. Orientation consisted mostly of explaining where the supplies were, what the assignments were, and what was expected of me during a shift. I didn't have any expectations coming in as to how I would have to deal with the patients and their disease.

To my surprise, and probably the surprise of everyone, I loved the job. it was an amazing experience, and I found that I connected with these patients. I became fiercely protective of them, and a lot of it was because they couldn't protect themselves. I was their advocate, and I took that responsibility very seriously.

When I first became a nurse, I started applying for jobs in different skilled facilities, but there was one in particular that just felt right to me. It was a facility that was specifically for Alzheimer's and Dementia patients. It was probably one of the best jobs I've ever had, and the company itself was wonderful.

Whenever I talk about my time as a nurse or caregiver in those facilities, I'm met with surprise that I actually enjoyed my time there. people don't understand why I would want to spend time with people that are confused, and who don't remember who I am, even if I saw them a few minutes before.

After working in rehab and in the hospital, I can say that the reason why I love Alzheimer's so much is the clean slate. I go in and talk to the patient, and no matter what, it's wiped clean. They don't remember. Now, that may not seem like a good thing, but for me it is. Nurses have to deal with a lot of cranky patients. And sometimes, we get cranky back. But when I work with Alzheimer/Dementia patients, they forget. If they get mad at me for making them change out of their dirty shirt, five minutes later, we can go back to having a happy conversation. If they threw their food against the wall because that's what they felt like doing, I have a much easier time ignoring the behavior because I know that they can't control it. There's also no point in getting mad, because they won't remember it anyway.

Even with their forgetfulness, they can remember aspects. They can remember how you made them feel, even if they don't remember your name. And sometimes, knowing them well enough that I can make them smile is all I need to have a good day.

Nurse Mentors

Last week, I talked about nurses eating their young, and my own experience with someone who tried to destroy my confidence as a nurse. If you didn't get a chance to read it, here is the story.

She'd gotten offended because I mentioned that I was an RN. Now, I didn't really study very much about the different types of nurses. All I knew was that a nurse was a nurse. For the NCLEX, I had to study questions where they gave a scenario with four different patients and ask which one was appropriate for an RN, which was appropriate for an LPN, and so on. But I don't think it really registered.

I've heard RNs make comments about LPNs. In fact, when I was having a difficult time with a co-worker, another co-worker asked me, "Did you tell her that you're the RN and to shut up?"

Here's the thing. I really respect LPNs. In fact, there are two LPNs in particular that became some of my closest friends, and that influenced the kind of nurse I became. The first LPN was this wonderful woman named Ellen. She and I were as polar opposite as could be. She was tall and boisterous and loved to get people riled up. I was quiet, shy, and barely spoke to anyone if I didn't have to. We worked together at my first job, and she took me under her wing. She showed me how to deal with difficult patients, with co-workers, and even with management. She always took the opportunity to teach -- in her own unique way. I was never afraid to ask her opinion, and I never got offended if she gave it, because we learned to work together as a team. Never once did I stop to think about her credentials. She was just my co-worker and we made sure that things worked smoothly.

When I moved to Idaho, I had another wonderful co-worker named Joanne. She worked nights with me, and we both seemed to think and function in very similar ways. We both walked fast, worked faster and always did a little extra so that things would get done the right way. She's the one who taught me how to navigate bigger facilities, and to become an effective leader, especially when it came to working with multiple CNAs. She helped me gain confidence in new skills that I hadn't used in my previous jobs, and I loved working with her because everything always ran so smoothly. Even in a disaster, there wasn't anything we couldn't work through.

Those two wonderful women were my mentors. I didn't care that they were LPNs. They were nurses, and they knew what they were doing. Instead of getting frustrated, they took the time to teach, and those opportunities helped me to develop my own style and talents as a nurse.

How about the rest of you? Any mentors you'd like to recognize?

Nurses Eat Their Young

There's a phrase in the medical field that nurses eat their young. It's a phrase that I've heard quite often, and that I've unfortunately seen just as often. It's true, we don't completely trust new nurses. They're just starting out, and they obviously don't have the experience that it takes to run a floor. Or to get everything done.

But here's the thing. We were all, at one point, a brand new nurse starting out.

When I first became a nurse, I had no idea about the politics that happened behind the scenes. the seniority that nurses get over others was surprising. I remember, when I was still orienting with a nurse, she commented that she couldn't understand why they would put me on the difficult hall, when she'd spent so many years on the hall she's on and hasn't been able to move to the hall they assigned me.

"Oh," I said, not even realizing how this comment would come across, "They said it's because I'm an RN."

We didn't get along after that. For her, she had experience behind her. She'd worked as a nurse for decades, and she knew and had experienced so much more than me. I, on the other hand, had a higher degree than she did, which meant that management wanted me to be on the 'coveted' floor. She ate me alive, and it was terrifying. After several months, she moved on to a different position which meant that she could spend a lot more time in my area, and she took advantage of it. She would search for things I'd done wrong, and I'll admit that there were a few times when she would drive me to tears.

Apparently, this was something she'd done before. My coworkers told me about a nurse who had her master's degree, and every time she came on shift, this nurse would make her sit in the corner and wait until she was ready for report.

I couldn't understand why someone would treat another coworker that way. Especially when we're trying to take care of the same patients. It wasn't until I became older and watched new nurses start out in their career. There are times that make me flinch, but I always remember my first experience, and how I needed someone to gently lead me, not make me feel like I couldn't do the job.

We need nurses who are confident. And confidence comes from knowing that we can do what we're asked. Nurses shouldn't eat their young. They should nurture them. It not only makes for a much better environment, but it also ensures that all of the staff are competent enough to take care of their patients.

How about the rest of you? Any stories about nurses eating their young?

Nursing and Time Management

Nursing school prepares you for a lot of stuff. You’ve got to remember medications. What class of medication are the beta blockers? What do the lols do again? Then you’ve got to remember how the body works. The way that each system of the body interacts with the other. Now if your kidneys are malfunctioning, how does that affect the heart? And what do you do if they go into liver failure?

There’s so much to remember, and in the short time that you’re in school, information is being crammed into your head as fast as physically possible. Until you think there’s no more memory space left.

Then comes the day you take the NCLEX, the day that terrified me beyond anything else. Trying to recall everything I’d been taught for the past four years? Staring at up to 275 questions and hoping that I finish above the line? That’s the kind of pressure that nursing school prepares you for.

Here’s what nursing school doesn’t prepare you for: Time Management.

No one cares how well you did in your classes, or how well you did on the NCLEX. In fact, when I was doing my preceptorship, I remember sitting with my preceptor and her friend and they were talking about another nurse. She was really struggling, and she just couldn’t seem to get her work done on time. They commented on the fact that she was a straight A student, and they were both C students in school. The difference was that they knew how to manage their time and prioritize their work.

Grades matter very little in the real world, unfortunately. I remember when I was training a brand new nurse who was really struggling. I was in a facility where the nurse was in charge of twenty patients. That included wound care, medications, notifying doctors and assessments. There was a never-ending list. She couldn’t keep up, and usually, her morning med pass would finish right when she needed to start her noon pass.

I sat down with her and told her my biggest lifesaver. At the beginning of my shift, I look over my list of patients. I go through their medication times and then put them in order of who needs it first. Then I work down the list. Obviously, things change, but as long as I have a general game plan, it makes the day much easier to survive. That way, even if there’s an interruption, I know what goes next on my list once things have calmed down again. I also told her to cluster her care. Does she have a dressing change? Do it when she takes the pills in. She’s already in the room, and that way, she doesn’t have to backtrack to do all of her dressings later in the day. It takes maybe fifteen minutes to go through the list and write it out, but it saves so much time in the long run.

Now that I work in the hospital, I still do the same thing. It’s a little different, since I know that at any point, I could have a discharge or admission, but it’s the same general concept. I have to be aware of the time I’m given and what I need to do within that time. Then I make a plan and work toward it.

Patients That Changed My Life: Susan

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy purposes, I won’t use real names, but I want to tell you their stories.

To read about previous patients, click here.

When working in skilled nursing, sometimes it’s so easy to go through the motions. We have a huge cart full of cards and each card has a medication. We pull the cards out, we check the boxes or click on the button to indicate that we’re giving the medication and then we carry the cup of meds into the patient’s room.

I had one patient, Susan, who was admitted in the later evening, and her admission was a little bit of a mess. She was having a difficult night, which is understandable. No one wants to be in a skilled nursing facility. Add to that, doctors just couldn’t figure out what was wrong with her. She was grumpy, and most of her medications weren’t even in the facility. I spent the evening running around, calling pharmacy, searching our pixus and generally pulling my hair out. Finally, I got the majority of the medications, brought them to her room and she had decided to take a shower. So I labeled the cup with her initials, put it in the top of my cart and continued to the next patient.

About twenty minutes later, Susan asked for her medications. I grabbed the cup and brought it into her, and she asked me what the medications were. I honestly couldn’t remember. I’d prepared them twenty minutes before, and I’d passed medications to at least three or four other patients since that time. She was appalled and told me that she wouldn’t take any of the pills until I could tell her what they were.

I’ll admit, it was a long night. Susan and I went back and forth several times before she finally took her meds. But she taught me one of the most important lessons I’ve ever learned as a nurse. It’s too easy to go through the motions, or to take an order and just follow it. As a nurse, we should be doing more. We should know exactly what we’re giving our patients, and why. They depend on us. This patient was able to ask questions, to tell me that she wasn’t comfortable with specific medications. There are others who don’t have that luxury.

Since then, I’ve always stopped when preparing medications. Whether I’ve done every night for the past six months, or whether it’s their first night in the building, I always make sure that I know what they’re taking. And I make sure that they know what they’re taking. It’s my responsibility to protect my patients, and the best way to do that is by keeping them informed.

Nursing Burnout

Now that I work in a new place, I’ve been watching nurses. Mostly because there’s so many of them! In most SNFs (Skilled Nursing Facilities), I work with maybe 2 or three nurses at night, if that. In the hospital, things run a bit differently. But here’s something I’m starting to realize.

No matter where you work, burnout is a very real thing.

There are some nights when things just do not go right. (And days too, bad shifts do not discriminate). I think I’ve actually seen more nurses break down crying at this job than in other place. Crying because they’re overwhelmed, or they can’t catch up, or because there’s one specific patient who has tried their patience beyond anything. I’ve been there. Sometimes, I’m the one who breaks down crying.

Burnout is a huge problem in nursing. We deal with the day to day activities of the patients. We have to watch out for their care, keep an eye on their labs, and their orders, and we have to take most of the crap we’re dealt with a smile. It’s enough to make anyone feel frustrated.

Unfortunately, I haven’t learned the magic trick to dealing with burnout. Most of the time, once it gets to the point where every shift feels like I can’t get my work done, I tend to start looking for another job. In SNF, I’ve found that management likes to work with bare bones. Heck, I was management at one point. I understand the bottom line. But that doesn’t mean that the line we’re given is enough for the patients or the staff. Just because state tells us that we can function with that level of patients, it doesn’t mean that it’s true. So when you get a competent nurse (or CNA), it’s so easy to add extra work to their already heavy load, because there’s no other way for the facility to function. That’s when burnout tended to happen to me. When suddenly, they would cut nurses on the night that I worked because they knew I could pass the medications to all of the patients. Or the nights when I had a patient who was a 1:1, but they wouldn’t give me a sitter because they figured I could keep an eye on them.

I promise this isn’t a rant. It isn’t even complaining, really. It’s just a musing on the fact that nurses get burnt out. My solution has been switching jobs when I’m so overwhelmed that I can’t function. But I would love to know what the rest of you do to combat burnout. 

How do you reverse the process?

New Job

I recently started a new job at the hospital. I love skilled nursing, and I still think that geriatrics will always be my first love, but the truth is, I burn out too fast. Every facility I worked at, the workload would be manageable, until short staffing or increased workload would burn me out. In the past 3 ½ years I’ve lived here, I’ve worked 4 different skilled nursing jobs. That’s an incredible amount to me, mostly because almost every single one, I start out thinking that it’s a great fit. I’m excited to start, and I like the new way of doing things.

It’s an unfortunate truth of skilled nursing, that there’s just not enough staff. Part of it is the stigma of working long term. Very few nurses want to work in geriatrics. In my graduating class of almost 300 nurses, there were only five or six of us who wanted to work geriatrics. It’s not exciting or glamorous.

Add to that, it’s getting increasingly difficult to earn money through skilled nursing. Patients can’t afford it, and families hate the idea of putting their parents in a ‘home.’ There’s more options now, like home health, which is more affordable, and more Assisted Livings are expanding, so that they can take patients that they may not have been able to several years ago. They might have an oversight nurse, or their own home health to take patients who have insulin or wounds.

Skilled nursing has really been struggling. At least from my vantage point. State’s regulations are pretty clear about staffing ratios. Unfortunately, those ratios don’t benefit the facility, the staff, or the patients. Most nurses and CNAs feel understaffed when in reality, they’re staffed as adequately as state allows. And when money needs to be cut, it comes from the support, whether in charge nurses, management nurses, or even the hours of Medical Records. I’ve seen all of that happen, and unfortunately, the extra load always falls on the floor nurses.

So for now, I’m taking a step back and trying something different. It’s difficult, adjusting my mindset from long term to acute nursing, but I think it’s the right step for now.

I hope that someday, I can return to geriatrics, because it will always be my first love.

Night Shift as the Clean Slate

I love working nights. I could work four or five nights in a row without a sweat, but when I have to work days, three is probably my limit. I do not do well with waking up early. When I work days, I’m always worried about going to bed on time, or early so that I get enough sleep. When I work days, I need a good 7-8 hours of sleep. When I work nights, I really only need 5-6. I can’t explain it, but my sleep schedule just appreciates nights better than days.

There’s other advantages to working nights. There’s less chaos during the day. I always think of night shift as the clean slate crew. They take all of the leftover needs, clean it up, and leave it fresh for a new day. In one facility I worked at, I would spend my entire first night going through orders, double checking that everything had been filed correctly. In another, I would actually reorganize the nurses’ station, because everything would get tossed around, left wherever, because the day shift didn’t have time to put things back. Sometimes, I would even wipe down the counters and sweep the floor.

Even when I worked management, I still believed in the importance of a clean slate. Before I left for the day, I would organize all of my thoughts, make sure that I didn’t leave any loose papers on my desk, and then wipe down my desk. That way, I know that the next shift – still me, wouldn’t have to clean up from the day before.

In one facility, when I was off for three or four days, I would come back to a huge pile of orders and papers. Things that none of the other nurses deemed important enough to go through. Here’s the thing. When it’s just one day’s worth, it’s not that hard to do. When it’s three or four, then it gets a little exhausting to go through. It’s so much easier to clean as you go, but on day shift, that isn’t always possible. That’s why we need to work as a team.

There are some things night shift can’t do. Phone calls get hard. Doctors’ offices are closed at night, and calls are only for emergencies. I know day shift covers my back. Why not cover theirs as well?

So I do my part. I clean up, I organize, and I leave them a clean slate.

Patients and Patience

I love being a nurse.

Most of the time.

Just like any other job or career, there are ups and downs. Unfortunately, because of the nature of the job, nurses (and other healthcare providers) get to work with people who are sick. And sick people aren’t always happy. I don’t blame them. I’m not happy when I’m sick either. You feel gross, and on top of that, you just want to sleep. Then we come in, wake you up and ask you a million questions. We ask about your bowel movements, and force you to use a pain scale about something you can’t even quantify.

I don’t blame my patients for getting a little short with me.

Then there are the ones who are so demanding that I wonder if they understand how healthcare works. When I work in a skilled facility, my typical patient load is anywhere from fifteen to thirty patients. I don’t even have time to go into everyone’s room in an hour, or even two. I run for hours without stopping, and I do my best to meet everyone’s needs.

When you talk to a nurse, you have no idea what other things are going through their head. Maybe there’s the patient next door who’s having a hard time breathing, and she’s waiting for a call back from the doctor. Or maybe three other patients need pain pills, and she stopped in your room on her way to get them. Maybe she’s about to get an admit, and is trying to get everything under control before things get really hectic. Maybe she just had a patient die, and is grieving for their family. Or maybe it’s the first day of the month, and she still has to change over all of the charts for the new month. Then there’s the possibility of issues at home. 

We’re all humans, and we all carry baggage.

No matter what, we hold it in, and we put a smile on our face, because you're important too.

For those who are patient with me, I can’t tell you how much I appreciate it. The reason I got into nursing was for the opportunity to make someone feel better. I know my shortcomings, and I know that there are times when I won’t ever live up to expectations. But I have no intention of making you feel worse, or making you feel guilty for asking for help.

Please remember that your nurse is on your side, no matter what else is happening. 

Simple Words

Sometimes, as a nurse, I feel like a glorified waitress. And a maid. And a personal butler. There are the patients who ask me to clean their room, or who want me to warm their food to a specific temperature. Or who need me to tuck them into bed just right. Or help them figure out how to use their electronic devices. Or change the DVD in the DVD player. I’ve had patients who want me to snake their toilets and others who want me to dial numbers on the phone for them.

Usually, I don’t mind. But there are the days when it feels like some patients don’t understand that I have more than one patient. And then there are the patients who call me into their room, and moments after I leave, they call me right back in. I’ve had patients who are on their call light thirteen or fourteen times an hour, and since there’s always a ding overhead when a call light goes off, it gets exhausting.

Imagine the scenario where I go into a patient’s room to give them their medications. We talk for a few minutes, and then when we finish I leave. Thirty seconds later, they call me back in and ask if I can close the blinds. Sure. No problem. I do that, and then I leave again. I get halfway down the hall when the familiar ding-ding starts again. I go in and the patient gives an apologetic smile and asks me to get a coke out of their fridge. Great. I grab the coke and again try to get back to my work. Halfway down the hall… well, you guessed it.

I hated working with those patients. I felt like they were doing it on purpose, or that they were wasting my time. Why couldn’t they just ask me when I was already in the room?

A few years ago, I worked at a facility where the administrator wanted staff to focus on six important words.

“Is there anything else you need?”

Before leaving any room, he insisted that we ask the patient if they needed anything else. It’s so simple, yet incredibly effective. I didn’t expect it to save me much time, but I’ve found, after putting it into practice, that when I’m not spending half of my time walking up and down the halls, I actually do get things done faster. And both the patient and I are much happier.

Imagine the same scenario. I go into a patient’s room and give them their medications. We talk for a few minutes, and then when we finish, I go to the door and ask, “Is there anything else you need?” Why yes! She wants me to close the blinds. Sure. No problem. I reach over, grab the blinds, and that’s it. “Anything else?” She wants a coke from the fridge. Got it. We do that until she shakes her head and can’t think of anything else.

That’s it. Such a time saver, but I never would have thought of it myself. Even though I’m no longer at the facility where I was taught to ask, I still put it into practice today. And I think I’m a better nurse for it.

Patients That Changed My Life: Dorothy

As a nurse, I have the chance to meet a lot of people from all walks of life. Some are fun, some are not so fun. Then there are those that change my life, and changed the kind of nurse I am. For privacy purposes, I won’t use real names, but I want to tell you their stories. To read about previous patients, click here.

Several years ago, I worked at an Assisted Living. Those facilities are usually for people who can take care of most of their needs, but need help with a few essentials, such as cooking or taking medications. Because they’re supposed to be fairly self-efficient, there’s a lot less staff then there are at a skilled nursing facility or hospital.

I had one patient, Dorothy, who was a very sweet lady that loved to walk around. She would take her walker, and her little dog, and they would just cruise around the nursing home all day. She would visit other residents, go outside and sit in the sun, or gather in the front room. When I first started working there, she pulled me aside with one very special request.

She wanted someone to cut her toenails. It’s something so small that it would only take a few minutes, yet no one seemed to have the time to help her. Most CNAs can’t cut toenails because of the risk for infection, especially in diabetic patients, but nurses can. I went into her room before I went home, and I cut her nails. It was such a simple act that I didn’t even think anything of it. But for her, it made her day. Actually, it made her week. She was so grateful, she came and found me every day to thank me.

We don’t need to do something big to make a difference in our patients’ lives. Something as simple as brushing their hair, shaving their face, or cutting their toenails can transform their day.