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”

Sunday to Sunday

I started this post last Sunday (7/22/18) It feels as though everyday is a fight against/with depression.  I don’t know the last time I “checked in” with myself but I know that every time I “check in” (or maybe every other time) with myself the conversation sounds about the same  “why am I so tired and in so much pain” “have I been absent from mindfulness for so many minutes, hours, days, weeks that I have forgotten something important” “have I been taking my medicine” “this can’t be a normal way to feel”

Sunday’s seem to be the worse for self reflection. Especially if things haven’t been great for me!

Since I didn’t complete that post I will use this as an opportunity to point out the difference a week can make! 

I am in a much better mood this Sunday. I’m sitting here now, reflecting on the last week. I am not sure what has contributed to this better mood but instead of coming up with something to answer the above question, my mind wondered off to many other things!  Before I moved back to Decatur in 2013 I had very little opportunity for stability which meant I was always rushing through things because I knew something would soon be changing ie: where I lived, where I worked, going to school and so on. Now for the first time I have lived in the same place for 5 years and I was working at the same place for 5 years. I’ve been in the same place long enough to see the 3 younger kids have all graduated high school and have went to college and are living on their own. I’m rambling aren’t I? Well to reign it all in: I’ve never had the stability that I now have which has afforded me the opportunity to catch up with myself and even start to like myself! I just registered for college again! I’ve always wanted to get a bachelors degree and I’ve always wanted to get paid for doing something I like…..helping people…….but nursing wasn’t meant to be forever……..

To understand why nursing wasn’t meant to be forever I am writing another post: “Nursing in a Nursing home”

For goodness sake….I don’t think this post has actually been about anything in particular!!

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!!

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.

 

 

LPN-Charge Nurse Part 2

The only subject that I could possibly go on and on about is being a mom. The next subject is: healthcare. In 2004 I was living in Springfield and working for Bank One. Some one asked me what I wanted to do in life and of course me being me I said: help people. I thought that’s what I was doing at the bank but as it turns out #1: you can’t raise 4 children on the wages of a customer service rep at the bank #2: it is nearly impossible to feel like you are helping people when you come between them and their money!! This person that asked me what I wanted to do suggested nursing. (I WAS SOOO NAIVE AT THAT TIME) I thought: wow, nursing would be great!! I can genuinely help people AND support my family. Additionally I believed that everyone in healthcare was there to help people, not JUST to make a paycheck. 

Throughout nursing school I couldn’t decide where I wanted to work after graduating but I was absolutely sure that I didn’t want to work in Long Term Care (LTC) those facilities were just the worst. 

During clinical we did a few rotations at nursing homes, a few at the hospital and some at random sites. One thing that stood out to me about Long Term Care was the LONG TERM part. I realized I may actually fair better being a nurse in LTC because the residents don’t change as often as the hospital. In 2005 when I graduated from nursing school I was living in Springfield but I knew more people and places in Decatur. I found out that a LTC facility in Decatur needed a nurse on day shift so I applied and was hired. 

My first job was a locked alzheimer’s unit, day shift, 40 residents to myself. The situation was less than desirable but that was actually a positive. After working there every place was better and I was well on my way to a more confident me!

LPN-Charge Nurse part 1

So, it is an ongoing stereotype that LPN’s aren’t real nurses (that would be an RN “real nurse”). However the majority of LPN’s have either been nurses wayyyyy longer than any RN they work with AND the majority of LPN’s tend to work in nursing homes, aka: long term care. As an LPN or “Charge Nurse” in a nursing home you have far more responsibility than you could ever imagine. It is often a thankless job as with plenty of other healthcare and/or  social work positions.

There has been so much learning, advocating, doubting, yelling, crying, loving situations over the last 12 years since I graduated from nursing school. This job has been scary, exhausting, gut wrenching, rewarding, fulfilling, best ever years of my life. I’ve always loved helping people!

I was so unsure of myself, especially the first 22-25 years of life. I worked for several gas stations but I wanted to work at a bank. At this time I was 22 years old. I had just had my youngest (Alexa) 4 weeks prior to my fist interview at: Soy Capital Bank. At the very end of the interview I felt by milk come in (at the time I was still breastfeeding Alexa. I felt the milk come so I tried crossing my arms over my chest without being noticed: thus I could apply enough pressure that I wouldn’t actually release milk on to my beige top. I successfully kept it at bay for the remainder of the interview and went home, waited for a phone call which I received the next day “Sunshine we have decided to offer you a full time position” (inside my head I’m thinking: Oh My God, thank you so much for taking care of me God!) but I respond calmly:” thank you so much for this opportunity I can start on Monday” (this is one of my favorite topics to bring up when I want to embarrass the kids! I love to say in front of their company “hey remember when I breastfed you” . I realize this would be offensive to many people but somehow my kids thrive in these situations, they are so quick witted that they always have a come back and nothing ever has time to become awkward.

After the bank in Decatur I worked at a title loan company. In 2001 I decided I was going to move to Springfield. In 2004 I was asked what I wanted to do. I responded “I want to help people, maybe I’ll become a social worker…………..

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