I’ve been working as a nurse in long-term care for nearly 13 years. All 13 years have been in Illinois. Every time I come across a rule or regulation that seems absurd or somehow negatively impacts my residents I’m reminded that it’s the great state of Illinois who makes these rules. I absolutely love the concept that the people making rules for my residents are people who have never worked in long-term care. Now I’m sure that there is a rare instance when someone somewhere has been involved in the rule making process that has worked in long-term care but it’s not the norm. So when it comes to which medication my resident can take, if and when my 85 + year-old resident can have something for pain, if my resident can have a 6 inch wide bed rail to help them move around in bed, it’s up to the state of Illinois! My favorite though is the supposed Patient to caretaker ratio that has some magical formula that no one is really privvy to!! Supposedly my facility staffs Above This magical ratio of worker to patient which coincidently is decided by states themselves. There is no federal regulations!! As best I understand, each resident is required so many hours of patient care in a 24 hour period. So who gets to decide how much time each person deserves!?!? Here’s what I do know, our facility has roughly staffed our facility with 8 residents per CNA and anywhere between 15- 45 residents per nurse depending on the shift (the Medicare hall had the least amount of residents but the highest amount of charting) 15-30 on first and second shift, 45+ on night shift. Compared to other facilities these are decent staffing ratios, but we still have people waiting forever for basic needs: 20-30 min for the toilet, high fall statistics and too many UTI’s!! I thought I would never put this in writing but my God, I’ve come to the point that I work 2 hours over every night so I can go home with a nearly clear conscience!! My CNAs are exhausted by the end of their shifts (now that my kids are grown I prefer second shift because I don’t have to deal with day shift nonsense but I get to sleep in my bed at night) the only problem is that we have half the staff of day shift and all the fun off Sun Downers!! So above all, I thank the great state of Illinois and our ridiculous governor’s for making unrealistic rules (not to mention stealing money) and for continually lighting a fire under my ass anytime I think I can take a break from advocating for my residents!!
I just came across a blog that had people comment about their fears and then asked others to respond with encouraging words. I felt this afforded me the opportunity to write about something I see quite often in LTC: fear and or acceptance of death and dying. I can’t express enough how very important it is that families discuss (more importantly put it in print) what they want to happen during end of life care! So many times families are not on the same page!!
I would just like to put my 2 cents in about suffering at the end of life. I have worked in LTC (long-term care/nursing homes) as a nurse for the last 12+ years. It is of up most importance to me that residents (that is what we call patients in a nursing home setting) and their family members understand the options available to them to keep comfortable when they are terminally ill. The need can be days, weeks, months or even years! Our house Dr has a list of orders that we put in place for comfort: pain meds, suctioning, different mattresses etc. This is pretty much the norm for hospice care as well. I urge everyone to be open and honest with loved one’s about what you see as “keeping comfortable” . It is so much harder to make these choices in the moment. Another great tool is: 5 wishes! Basically it is a form that you fill out to let everyone know what you want for end of life care. I know there are many reasons people fear death and dying but I feel that it is far less scary for those that make plans ahead of time!
2 things that break my heart:
1. “This isn’t home” I am constantly told that LTC is a beast of it’s own and can’t change it. Well guess what!?!? The facility I work in belongs to my residents and it is always up to them how my night goes. It is impossible however to convince my supervisors of this! They have asked me more than once (I have to give much love to my nursing supervisor Nicki…she is always going to bat for me even when I make her crazy) Getting back on track…..the biggest complaint from my residents…demented or not….. “this isn’t my home” I absolutely love how emphatically my “confused” residents tell me this! If they start out my 2-10 shift in this mindset I know it is going to be a 2-12 shift…….and nowadays this is most shifts!
2. “I try to do what I am told” if my resident tells me this…..it is on like Donkey Kong….heads are rolling one way or another!!!! I always respond: This is YOUR home and we are to do what YOU say!!!! We are here for the residents, it is their home and if it wasn’t for them then we wouldn’t have a job to begin with!
Moral to the story: Every day I go to work and I feel that I am faced with a moral dilemma: nurse according to the definition set forth by the state of Illinois: most nurses know that isn’t realistic, nurse according to my supervisors…much more doable but no where near “realistic” or piss off everyone in the front office and spend each shift nursing as though the shift is flexible and completely up to my residents!
I am beyond furious and due to a complete lack of ability to change current events, I am going to blog about a personal event going on with my family. Typically I wouldn’t really be ready/willing to post about this but I have to get out my overwhelming frustration somewhere, somehow.
1: My son is currently in the Piatt county jail in Monticello, IL. He just got out of prison about 2 years ago and completed parole a couple of months ago. Then he was arrested for supposedly making someone else commit a crime. Apparently the states attorney has come to the conclusion that they do not have enough evidence to charge him but they are probably going to let him sit there throughout November and December.
2: Today I went to visit my son and the police chief showed up to take my phone because I supposedly threatened my daughter in law about testifying against my son. I in no way buy into conspiracy theories but this is at least the 3rd time the F.C. police department has wreaked havoc on my family.
3: I’ve reached out time and again to get help for my son before life got any worse for him and he is the very reason why I am so passionate about advocating for mentally ill, those in poverty and the terrible treatment going on in all American Jails and Prisons! Everyone thinks that since it is America that our prisons must be forward thinking but they absolutely are not!
For sh*ts and giggles I am posting the conversation between myself and my “daughter in law” so folks can judge for themselves!! I have to preface this with a couple of disclosures: 1. I was using speak to text 2. I can’t explain why Chealsie talks the way she does.
I think nowadays people go crazy with diagnosis but if I were going to diagnose myself other than the obvious bouts with depression I would have to say I have terrible adult ADD! I say that half serious and half jokingly. They have tried me on a couple of ADD medications but the side effects are too much. I’m truly all over the place though whether it’s at home at work or in my mind. As any long-term care nurse would tell you the only way to get work done in a timely manner to be well organized. That just isn’t me needless to say and in addition to that my personality requires me to spend more individual time with my residence then an 8 hour shift will allow me. The administrative staff at my facility love most things about me, except my overtime of course! They have been trying to figure out a way to keep me around and decrease the overtime. The result is 12 hour shifts! This isn’t a terrible idea and I worked then 4 years ago when I started. I’ll be working 6p-6a which starts in November!
So, I want to cover a few points before I actually get started. For those who don’t understand the title, there was a movie that first came out in 1972 and then quite a while later was remade and the name of it was: Stepford Wives. The point I got from the movie was that a man created the ideal wife (in his eyes) and then made or cloaned many more just like her. As I write the description I realize that the fact that I have to explain the title means that I am really freaking old.I’ve always thought that men have man theories. I’ve noticed if you ask a man a question of any depth they always have an answer that they believe with all their heart which in turn sells the story to us! Well, in this blog post I’m going to give you Sunshine theories…..I’m going to state it so passionately you will be tempted to take it as fact……I’m telling you upfront this is only what I think and/or feel and I’ve come up with it through a combination of personal experience and information online…..you know, like: “Dr. Google” and such. I take being a nurse very seriously and 2 things that every nurse should have directly following compassion is professionalism and common sense. My point being: I tend to wear my heart on my sleeve so please know that I don’t say anything about nursing lightly. I have the up most respect for my residents, their families and the facility that I work for but I do it with a great deal of heart which often looks like stress to everyone else. As I’ve mentioned before , I have worked at my current facility for 4 years. I have worked the same “hall” or “pod” the entire time. The first year I worked 12 hour shifts overnight. We then changed to 8 hours shifts. I started working 2nd shift a shift myself and many others have avoided at any cost. For those of you who aren’t aware of the dynamics of nurses and cna’s in LTC, every shift is it’s own animal/adventure and for some reason there is always animosity between the shifts. At any rate it can be hard to keep staffing on 2nd shift because it takes up the majority of your day. I’ve grown to love the shift except for Sundowners. Sundowning is a symptom of Alzheimer’s disease and other forms of dementia. It’s also known as “late-day confusion.” If someone you care for has dementia, their confusion and agitation may get worse in the late afternoon and evening. In comparison, their symptoms may be less pronounced earlier in the day.
As I pointed out earlier every shift is different and each shift: Day, Evening, Night or 1st, 2nd & 3rd shift have their own special difficulties. I’ve worked all 3 shifts over the last 12 years so I understand that 1st shift is super busy but you also have more staff, 2nd shift is hectic because there is less staff and often or always (it seems) has more behaviors. 3rd shift has the least amount of staff (often the bare bones minimum) which wouldn’t be too bad except for the residents who not only refuse to sleep (because that in itself isn’t bad) but inevitably the residents that can’t sleep at night are also either the loudest residents and so they holler out all night or they are the residents who are not safe to transfer by themselves and like to pop up out of their seats or beds every 5 seconds.
This year has been increasingly difficult on my hall. No other nurses want to work it on my days off and all the CNA’s are getting overwhelmed. I know it is because I have a heavy hall when it comes to behaviors. I’ve always helped the CNA’s which of course puts me behind but as of recent it has been impossible for the residents to get the level of care I expect without me micromanaging the hall/shift. So the powers that be have decided that I should “take a break” from my hall.
In my mind that means I am throwing my residents and CNA’s to the wolves! This is very obvious proof that things should change in LTC. There are the very task oriented nurses (that I am not) that can get everything done but often lack compassion. I attempted for a week or so to be that nurse (stepford nurse) my supervisors said: “We have noticied you staying on task lately” and I responded: “I know how to be the kind of nurse you want me to be, that just isn’t me”. I think it was in that moment that it became clear that in order for me to give the individualized attention I desperately attempt to give each day something would have to change.
Everyone on the outside blames the facilities but the fact of the matter is they should also be blaming insurance and the state the facility is in as well.
Although we are caring for human beings that pay a lot (or the insurance/state pays) and these folks have worked their butts off their entire lives and deserve to live out the remainder of their years with the best of care, in the end it still comes down to money and if the state isn’t paying (along with other money issues) then things will always remain the same. I am not completely naive, I realize facilities could come out of pocket for some things…..but out all the facilities I have worked at, my current facility, tries the hardest to provide appropriate staff and a very family friendly space. We have the best family involvement (at times they are very very involved, God Love Them!) that I’ve seen at any facility. Our facility holds activities that encourage family involvement and families, no matter how large can come eat with their family member at anytime for no cost!!
So here I am faced with a choice that really isn’t mine…. I have to take a hall with less residents if I want to provide nursing care in a way that allows me to sleep at night.
It didn’t take long for me to realize and/or be told that the nursing home isn’t a home according to my residents. I’ve been working at my current nursing home for 4 years (in September officially). I’ve worked the same hall all 4 years and 2nd shift for the last 3 years. About a year ago I decided to start taking my residents down the hall after supper and “hang out” with them while I pass meds. Initially I did this to take my residents out of the common area because waiting in the t.v. room until you get your medicine and/or go to bed was loud, obnoxious and very impersonal. This process has evolved since I started. This affords me more time with my residents, prevents falls and gives me a chance to make sure work is getting done without me following people around. Having said this, there have been many naysayers about my methods but I no longer worry about them.
Our nursing home sits very close to a wooded area so we often see wildlife: deer, raccoon, birds, beavers etc. Lately 4 little baby raccoons have been coming up to the porch where my residents sit. The residents absolutely love their visits, it always puts a smile on their faces. There is about 2 foot of glass between them and the raccoons. Last week it was hot one of the raccoons hid in the bird feeder. I realized they could use some water. Yesterday they showed up and played in the water. Here are the pics…….
In healthcare/nursing you supposedly shouldn’t get close to the people you take care of and/or have favorites! Mine passed today…. Will miss you dearly! I hope you are giving them a run for their money up there!
While the kids were growing up I worked day shift. So from 1993-2013 I never slept (OK maybe a little) but I certainly never slept in! When I became a nurse in 2005 I had to work day shift because I had to have the kids in daycare. Of course getting a daycare to take kids at 5:30 am wasn’t easy and getting them there was much more difficult!!
In 2013 when I moved back to Decatur I worked 6 pm – 6 am for a year and then when to 2 pm – 10 pm. I had no idea how much I would love these hours. Needless to say morning time is not my friend. I try to steer away from morning appointments when at all possible.
Being a nurse on 2nd shift especially in long-term care brings its own special set of negatives/positives. It often means more interaction with the family members. It also means fewer staff members. Very little ancillary staff. And thanks to sundowning a remarkable amount of increased behaviors. I often feel like I am in an episode of Twilight Zone, I am not saying this in a negative way. All the excitement makes the time go quicker!! LOL
So I am a firm believer that it is of the up most importance to be “normal”. I’ve come to the conclusion the the previous sentence is proof of my ongoing bout with insanity! Let me attempt to explain how this has anything to do with the title.
Everyday I exclaim to my coworkers “you have to be a little crazy to survive working in healthcare”, I state this to cover a few topics that my self conscience brain uses on me daily: 1: I should be normal and although I don’t know for sure what that means, I know that it lies somewhere in the June Cleaver household (those of you under 40 will need to google the relationship between June Cleaver and “normal”) 2: Because I can’t “live up” to that version of normal I must be “crazy” . To prove to myself that all my actions are acceptable I have to believe that “you have to be a little crazy to survive working in healthcare”. No one should have a thought process this complicated!!
Lastly, due to the insanity of LTC there isn’t quite the excitement or enthusiasm in celebrating anything in the title this year!
Lastly, lastly ask me again in 2 days and I’ll think nursing is the next best thing to sliced cheese!