“Nursing in a Nursing home”

Pretty early on in my nursing career I started planning an escape. Looking back I realize this was much like relationships I didn’t want to be in. I would stay because it was easier then starting anything new. At times I would stay in spite of how miserable I was……..in nursing and in relationships. Additionally I may not have left if someone hadn’t opened the door and shoved me through!

I quickly came to loathe the feeling that I couldn’t change things that bothered me such as passing pills to 29-54 people twice in an 8 hour shift and deal with emergencies and trying to give everyone the time and attention they deserve!! So many times I’ve tried to understand why these hardworking retired folks are treated like it is a nuisance when they ask a person (being paid to take care of them) to take them to the bathroom. An even better question is : Why does the person being paid to take care of your mom taking care of a minimum of 7 other people, therefore making it difficult to take everyone of these often physically or mentally impaired or both to the bathroom every time they ask, or every 2 hours if they can’t ask. The reality of it is: your mom is lucky if she get’s taken to the bathroom twice in an 8 hour shift!

—-In  2012, total spending (public, out-of-pocket and other private spending) for long-term care was $219.9 billion, or 9.3% of all U.S. personal health care spending. This is projected to increase to $346 billion in 2040.42 [Updated February 2015]—-42 National Health Policy Forum (2014) The Basics: National Spending for Long-Term Services and Supports. Retrieved (January 2015) from http://www.nhpf.org/library/the-basics/Basics_LTSS_03-27-14.pdf

I have been pondering the whole “nursing in a nursing home” thing lately. I’ve come to realize I can’t see where anyone actually knows what happens in nursing homes, like no one even discusses it. Well I’m really thinking I’m going to write some posts that are candid about “nursing in a nursing home”

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The great state of Illinois!

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!!

Stepford Nurse

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.cookie cutter nurseI’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. man theoryI 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.                                                                                                                                            nurse means                              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.Clinician-Well-Being-Graphic-768x646.png

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.medicaid LTC.png

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.

 

 

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