Nursing in a nursing home 2

This first picture (I’ve used elsewhere on here) is me , my Mom and Melissa. This 2nd picture is since my mom had a stroke. In 2002 she had a stroke, spent 6 weeks in the hospital and then 6 weeks in a rehab to home program in a nursing home. I thank God that this was before I was a nurse! I genuinely think I was clueless about nursing homes at the time. In 2015 my husband had a diving accident and spent 3 weeks in Carle clinic a ‘trauma center/hospital”. I noticed E V E R Y T H I N G the staff did whether it was right or wrong and I acted a fool several times when they did something I didn’t like.

So imagine that feeling for your loved one!alexaanddad

Better yet imagine a nurse (and their are many) that take their job personally, to heart, wearing their heart on their sleeve! It is emotionally draining to be a nurse no matter what! Then to add 30+ human beings to it and 2 med passes in 8 hours and then threats if you work over, threats if you don’t, threats on your license you caused and didn’t.  30 human beings with a past, with a heart and a mind and a family that sees them how they were and wants you so badly to see that person the way they do so that you never forget that YOU are the person they are counting on to take care of their Mom who raised them fearlessly, or their Dad that never let them down and they don’t want to let him down.  Being a “nurse in a nursing home” whether you are a CNA, LPN, RN (Rob Good you are my super hero) is no easy task and it is so very hard to be present in their everyday life and then go home and pretend like nursing homes are equipped to take care of someone’s loved one in a way that will ease your mind enough that you can go to bed and sleep without a heavy heart!!!!

They say nursing is one of or the most trusted profession, well let me say a couple of things about that! 1: I know how to do nursing by the book and anyone that tells you that nursing home nursing can be done by the book is a big fat liar! You can’t take care of 30 resident’s in a way that follows what “the state” claims they expect and what the very same people know is the reality!! 2: The thing I heard most or the compliment I held nearest to my heart as a nurse is/was: “Sunshine it is obvious how much you genuinely care for your people” I  believe that more often than not nurses want to do a good job for their patients/residents and many nurses have varying ideas on what that is!

Every nurse has their thing they are good at, something they aren’t good at, something they stay away from at all cost (I am terrible with phlegm) and of course it can never be at all cost because nurses take care of business. That is our job under any and every circumstance!

What does it mean to be a “good nurse”?

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Kati Kleber, RN
Kati Kleber, RN

 

“There is something about a good nurse. Having a nursing license and job doesn’t make you a good nurse. Working for 30 years doesn’t make you a good nurse. It’s not about being a good IV starter or being best friends with all of the physicians.

It’s so much less defined and measurable than that. It isn’t measured in letters after your name, certifications, professional affiliations or by climbing the clinical ladder.

It’s something you feel when you see a good nurse care for their patients. It’s that security you see in their patient’s eyes when they come in to care for them. It’s that nurse whose patient’s family member will finally go home to sleep and shower because they know their loved one is cared for with that nurse.

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“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”

5/11/18-5/16/18 The rollercoaster

So the interview was crazy on Friday. I thought I was the problem with the weird interview but then I found out later the lady interviewing me got fired. Saturday was okay. Sunday, Mother’s Day, my girls took me out to get lunch and a pedicure so that was nice. We had a late Mother’s Day supper and then on Monday I got to call to come back in for a second interview! Then on Tuesday I got a call saying I’m sorry we have to cancel your interview, due to previous job. All the while I’m trying to keep my footing and not fall into an abyss of self defeat I started a new medication to boot so I’m hardly able to keep my eyes open. If I continue to take it I’m exhausted and if I don’t then I’m doing nothing to treat the depression.

Unemployed

There is such a terrible connotation with being unemployed. Additionally when you are already depressed everything seems bigger than it is. The good news is, I have an interview tomorrow. The bad news is, I have an interview tomorrow and I have to give a reason for leaving the last place.

More good news, I’m leaving the house today!! Of course it’s 2pm on the 4th day but who is keeping track.

Everyone asks if I am ever anxious or ever have anxiety. I never feel I do unless I’m planning a get together or I have to speak on front of people. Having said that I think I’ve said before they’re constantly feels like something is looming over my head. I just don’t understand why I always feel like I need cheering up. Actually maybe that’s sort of the definition of depression now that I think about it.

I have all these wonderful plans all of which I could be working on at this moment but for some reason my present state of mine doesn’t seem to want me to get it done. It almost feels like self-sabotage LOL. I know for a fact that I could start a home health or senior sitter service and be successful because everyone that I’ve talked to you about it said they would certainly recommend me. So why don’t I complete the steps to get this going? I’ve been promising my husband for 2 weeks now that I would help him get an online store setup and I haven’t completed the steps for that either.

Dismissal

So, I was fired today. I’ve been trying to write post since it happen at 2:30 p.m. Monday. Naturally this will not help with the deep dark depression that routinely haunts me. The usual or familiar feeling of not wanting anyone to know what happen, the extreme worry and concern of how the bills will get paid, the extreme fear of never finding another job because they will wonder why you lost the one you had have been ever present today and kept me in tears much of the day.

So to review: 12 hours ago I had a full time job as a nurse. That seem to define me other than being a mom. Now, I have to make a conscience decision to not sit on my pittypot and that is just soooo much work.

All I can think of is the paper they handed me marked: dismissal

Anyone who has ever had me take care of their loved one has given me the highest of compliments. They are always so appreciative of my care for their loved one. Surely this will turn into a good thing.

I hope I will wake up tomorrow and I’ll feel so much better and the answer of what to do next will some how be right in front of my face!

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!!

End of Life Care

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!

Sunshine Etc

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!

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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