I've been off work for the last week or so after my ear surgery, giving me a lot of time to think...I loved this job when I started it last August. I loved the residents, and still do. I knew from the beginning this wasn't what I wanted to do forever, and already made plans to go back to school in May for my RN.
What is it about LTC that makes it so difficult? The CNAs, as I mentioned before, don't like being told what to do. Completely understandable. They're overworked and underpaid. But when so and so needs to go to the bathroom and I'm treading water to keep up with my duties, I'm going to pass it on to the resident's CNA. What about co-workers? I've decided that I need to work on my Poker face, and to withhold my opinion on anything and everything. The night shift LPN couldn't get her suppositories done because she was too busy solving the residents' puzzle? I won't say a word. She knows her job. The treatment nurse couldn't get her treatments done? Fine. Let it go...I don't really care any more about staying late and making sure absolutely everything is done. I make sure my stuff is done, charted, give report, and swipe my badge. It actually got to the point where I realized that I'm starting to not even care anymore because I'm so fed up with it. I do care about the residents, and I will keep doing my best for them. But it's discouraging when others don't seem to care for them nearly as much. =(
I've said more than once that I would love to open up a Victorian bed-and-breakfast type of house, but instead of a bed-and-breakfast I would take care of 3-4 people, working with maybe one to two other nurses. I wouldn't have to trust the CNA who says they changed so and so, because I would do it myself. In a perfect world, maybe.
Right now my saving Grace is going back to school. I'm tired of the politics and the burnt out nurses and CNAs....
Wednesday, March 24, 2010
Sunday, March 14, 2010
last 12 hour shift...thank God!
just finished my last 12 hour shift. what i was thinking when i agreed to work two 12's every other Saturday and Sunday, I don't know. I finally decided it wasn't worth it to me and told my boss I'd like straight 8 hour shifts. I like my family, and my boyfriend, and I'd like to see them once in a while.
i also got a letter in the mail, letting me know i got into the lpn to rn program, starting this may and finishing this december (only two semesters!). i'm excited, but nervous...back to school, bills to pay. but it'll be more than worth it once i'm done. i'm hoping to write more about it. i enjoy going back and reading what i wrote. going from full-time to registry is scary, but i know this is what i'm supposed to do. i just hope for everything to fall into place.
i'm a little frustrated with the CNAs at work. most of them, the vast majority, are great. i love them and appreciate how hard they work, and i try to thank them for doing such a thankless, emotionally and physically challenging job. i try to get in there with them and help them with the residents. there is more to nursing than passing pills, thank God.
but then there's the few that frustrate me to no end. i floated to the Alzheimer's unit for the last four hours of my shift yesterday and today. no big deal...it's a change of pace. after i left yesterday, a resident was fighting with another resident. i get this in report and read the nurses' note. i go on throughout my shift, and as i'm passing my 1800 dinner meds, i look up to see the CNA put these two residents right next to each other. in my mind, i'm thinking, "this is just asking for another incident..." so i ask her to please move one away from the other. she looks at me and says, "he's fine." seriously? so i look at her and tell her i can see that, but i'd rather he not sit next to this resident. she continues to insist that she was here for the incident and that he truly is fine where he is. finally she moves him away from the resident. i thanked her and continue with the med pass.
after dinner, i asked if i could talk to her one on one and explain my rationale for not having these two next to each other. her response? "they don't remember anything." i'm trying to be professional, but inside i'm getting mad. she goes on to say, "so we should care plan that these two can never be next to each other?". i told her that she is more than welcome to give me suggestions, but when i ask her to do something, she needs to do it. end of story. i didn't ask her to do anything that would put anyone in harm, or would risk her certification. i made a decision based on my thinking.
on the other hand, i was the float over to that unit. she has worked over there for 2 years. apparently the nurses that work over there let the CNAs run the show and hang out in the computer room away from all the action. so this CNA resented being told what to do. (all of this was explained to me by the NOC LPN who relieved me). I completely understand all this, and am glad she is taking ownership over her job. but part of my job is making sure the residents are taken care of and safe, as well as overseeing the CNAs.
i don't care that she's upset with me. i understand that's not the way it's usually done, and maybe i should just put in my four hours and keep my mouth shut and spoon their pills in and go hide in the computer room like a meek little nurse would do.
i might look i'm easily intimdated, but i'm not. especially when i'm mad. there's a reason my dad's nicknames for me growing up were either "princess" or "mouth" depending on the situation.
maybe i'm picking the wrong battles. maybe i should just keep my mouth shut and let it be. laissez-faire. but at the end of the shift, the resident was eating peacefully by the window, and there were no incidents.
i also got a letter in the mail, letting me know i got into the lpn to rn program, starting this may and finishing this december (only two semesters!). i'm excited, but nervous...back to school, bills to pay. but it'll be more than worth it once i'm done. i'm hoping to write more about it. i enjoy going back and reading what i wrote. going from full-time to registry is scary, but i know this is what i'm supposed to do. i just hope for everything to fall into place.
i'm a little frustrated with the CNAs at work. most of them, the vast majority, are great. i love them and appreciate how hard they work, and i try to thank them for doing such a thankless, emotionally and physically challenging job. i try to get in there with them and help them with the residents. there is more to nursing than passing pills, thank God.
but then there's the few that frustrate me to no end. i floated to the Alzheimer's unit for the last four hours of my shift yesterday and today. no big deal...it's a change of pace. after i left yesterday, a resident was fighting with another resident. i get this in report and read the nurses' note. i go on throughout my shift, and as i'm passing my 1800 dinner meds, i look up to see the CNA put these two residents right next to each other. in my mind, i'm thinking, "this is just asking for another incident..." so i ask her to please move one away from the other. she looks at me and says, "he's fine." seriously? so i look at her and tell her i can see that, but i'd rather he not sit next to this resident. she continues to insist that she was here for the incident and that he truly is fine where he is. finally she moves him away from the resident. i thanked her and continue with the med pass.
after dinner, i asked if i could talk to her one on one and explain my rationale for not having these two next to each other. her response? "they don't remember anything." i'm trying to be professional, but inside i'm getting mad. she goes on to say, "so we should care plan that these two can never be next to each other?". i told her that she is more than welcome to give me suggestions, but when i ask her to do something, she needs to do it. end of story. i didn't ask her to do anything that would put anyone in harm, or would risk her certification. i made a decision based on my thinking.
on the other hand, i was the float over to that unit. she has worked over there for 2 years. apparently the nurses that work over there let the CNAs run the show and hang out in the computer room away from all the action. so this CNA resented being told what to do. (all of this was explained to me by the NOC LPN who relieved me). I completely understand all this, and am glad she is taking ownership over her job. but part of my job is making sure the residents are taken care of and safe, as well as overseeing the CNAs.
i don't care that she's upset with me. i understand that's not the way it's usually done, and maybe i should just put in my four hours and keep my mouth shut and spoon their pills in and go hide in the computer room like a meek little nurse would do.
i might look i'm easily intimdated, but i'm not. especially when i'm mad. there's a reason my dad's nicknames for me growing up were either "princess" or "mouth" depending on the situation.
maybe i'm picking the wrong battles. maybe i should just keep my mouth shut and let it be. laissez-faire. but at the end of the shift, the resident was eating peacefully by the window, and there were no incidents.
Thursday, January 14, 2010
back again...
I stopped writing after spring semester, for whatever reason. Nursing Leadership and IV therapy came next, and then i was done. Much thanks to Doughboy for letting me practice IVs on him!! (especially for pretending he had Tourette's...nice). Graduating was surreal. Just because of everything that had happened in my personal life, it felt like a chapter being closed, and I was more than ready to move on. Somehow, looking back now I remember nursing school with fondness, and the only thing I would change now if I could would be to enjoy it more as I was learning. And I ran into one of my teachers yesterday, and thanked her. She taught Maternal-Child Nursing, a class that made me uncomfortable from the beginning. I've never dreaded going to class like I did that one. The idea of having children made me so uncomfortable...and then I realized it wasn't the idea of having children itself, but having children with the person I was with. So I made some changes, said my good-byes, and let him go. I hope he finds someone whom he can have an amazing relationship with, and I wish him nothing but the best. It just wasn't meant to be. So I ran into my teacher, and I thanked her as I explained to her that it was never her, or her class, that made me so disinterested. I guess I learned a lot more in nursing school than I bargained for...
So now I'm working as an LPN in a long-term care facility. At first it was the last thing I wanted to do after graduating, but with the recession, full-time jobs weren't plentiful as an LPN. And the way everything worked out...to me I knew it was where I was supposed to be for the moment.
I'm learning everyday just how much I don't know. Every time I start to think, "Hey, maybe I'm getting it..." something happens to make me realize just how much I have to learn. I've actually wanted to call my LPN instructor and ask her if I could just repeat those classes again...maybe then I'll feel like I'm more competent. But instead I ask questions. About everything. I remember Lindy, an Ortho nurse..."when in doubt, scream and shout." And I realized there are a handful of nurses I can go to who will point me in the right direction. Yes, some eat their own, but I decided to live and learn and just ignore their rudeness and try to learn from what they're nitpicking about.
I love the residents. Even when I'm in the worst mood, I could never be upset with them. They yell sometimes, spit their pills out all over me, but it's okay. And it's the crazy ones I love the most. The resident who asks me to put a blanket on her daughter, pointing at an empty chair. The resident who yells at me because now I'm her niece and I'm not dressed to take her to Mass. The resident who makes faces at me while I'm trying to chart on the computer. The resident who tells me the dirtiest jokes I've ever heard with a dead-pan expression (jokes so horrible they even gross my brothers out...). It's not about the money, because before I thought I'd be rich after I graduated. Not so much... It's not about self-gratification, because sometimes I go home and feel like I didn't do enough. It's simply about them.
I wasn't planning on blogging anymore. But lately I've had trouble leaving work at work, thinking about work while I'm trying to fall asleep, waking up, thinking about what I should do for the upcoming day. So maybe if I just write it down, I can leave it where it's supposed to be.
Today wasn't a bad day. It was just so hectic. Thank God another nurse was orienting with me, so she could focus on passing meds and I could try to keep up with everything. We suspected one resident had an URI (green, pasty/sticky phlegm coming up every 30 seconds, low-grade temp...). I called the MD yesterday, he ordered antibiotics. Trouble is, this resident refused to take anything by mouth, food, water, and especially meds. (When I speak of residents spitting their meds all over me, she comes to mind). We check her blood sugar (noting she hasn't eaten in several days) and at first it's too high for the glucometer to read. Which means it's over 600. (Normal is between 70 and 120/130). I repeat the reading, and it's 599. Yikes. Time to call her doctor. He orders blood work...so I draw the blood, send it down, and once we get it back, realize her white blood cell count is pretty high. I faxed that to the doctor, and his nurse calls back, tells us this resident just bought an all-expense paid trip to the hospital. She just came back three weeks ago, after getting pumped full of antibiotics for a suspected UTI, and looked great for a while. Hopefully she'll feel better soon...
Another resident complained of leg pain. I rub Arnica gel on her muscles with no relief. I give her her PRN Percocet, and an hour later, the CNA comes to find me, telling me the resident isn't responding. Not something you want to hear from a CNA about a resident. I go over to her, and see that her eyes are open, but her pupils aren't following anything. The expression "The lights are on, but nobody's home?" I never saw someone who fit that expression as well as she did. I check her blood sugar. Nothing unusual. I check her oxygen saturation and other vitals. Fine. The LPN who's orienting today brought her dachshund. And this lady loves dogs. So I put the dog on her lap. Slowly, she lifts her hand up and pets the dog and smiles. She's fine, but to describe it, this resident looks stoned. I left a note for the doctor, wondering if she needs something less potent. The doctor takes her off her Zyprexa instead, so we'll see how she is the next couple of days (by the way, the resident who asked me to cover her daughter with a blanket...this was her).
I didn't realize how much responsibility this job is until lately. I hate making mistakes. I catch so many little mistakes, and sometimes it's just highlighting the MAR to point out that hey, this person gets 40mg of Lasix at 8am, and 80mg at noon, so that the right blister gets pulled and used. And I make mistakes, too. I hate making mistakes, but I learn my lesson so well from them. A resident on Coumadin got orders to re-draw his PT/INR on a date. I chart it in Meditech, put it in the MAR, and forgot to order the lab to be drawn by the lab. So the PT/INR goes undrawn for over a week. But now you can bet the first thing I do is put that PT/INR lab order in. I don't want to be that nurse that insists on running to the boss and showing every little mistake so and so made. I will if there is a genuine, obvious med error. The day I found out about the PT/INR mistake? I realized the evening nurse prior to me forgot to give two different residents their pain pills. I did let my boss know, and she told me that nurse wasn't comfortable working that unit, and was actually the nurse who oriented with me today to get to know the people better. Everyone makes mistakes...including me. We're only human. It's just how we can prevent them in the future. I would love to have a stamp to use on new doctor's orders. Faxed to Rx? Check. MAR changed? Check. DC'ed blisters pulled from med cart? Check. Nurses' note in Meditech? Check. New labs entered in Meditech? Check. New labs on calendar? Check. But for now, it is what it is. Until I can convince my boss that we really do need that stamp so things don't get lost in the process.
I applied for school, to get my LPN to RN. I think I missed the deadline by a few weeks, so I don't know if I can get in. But I think now would be better for me to get my RN, before I get married again, and have kids. I actually met someone who I can't wait to have kids with. And I can't believe the difference...But everything happens for a reason, and if I get in, I'll be happy. If not, I'll continue to work, gaining my experience, and try again next year.
So now I'm working as an LPN in a long-term care facility. At first it was the last thing I wanted to do after graduating, but with the recession, full-time jobs weren't plentiful as an LPN. And the way everything worked out...to me I knew it was where I was supposed to be for the moment.
I'm learning everyday just how much I don't know. Every time I start to think, "Hey, maybe I'm getting it..." something happens to make me realize just how much I have to learn. I've actually wanted to call my LPN instructor and ask her if I could just repeat those classes again...maybe then I'll feel like I'm more competent. But instead I ask questions. About everything. I remember Lindy, an Ortho nurse..."when in doubt, scream and shout." And I realized there are a handful of nurses I can go to who will point me in the right direction. Yes, some eat their own, but I decided to live and learn and just ignore their rudeness and try to learn from what they're nitpicking about.
I love the residents. Even when I'm in the worst mood, I could never be upset with them. They yell sometimes, spit their pills out all over me, but it's okay. And it's the crazy ones I love the most. The resident who asks me to put a blanket on her daughter, pointing at an empty chair. The resident who yells at me because now I'm her niece and I'm not dressed to take her to Mass. The resident who makes faces at me while I'm trying to chart on the computer. The resident who tells me the dirtiest jokes I've ever heard with a dead-pan expression (jokes so horrible they even gross my brothers out...). It's not about the money, because before I thought I'd be rich after I graduated. Not so much... It's not about self-gratification, because sometimes I go home and feel like I didn't do enough. It's simply about them.
I wasn't planning on blogging anymore. But lately I've had trouble leaving work at work, thinking about work while I'm trying to fall asleep, waking up, thinking about what I should do for the upcoming day. So maybe if I just write it down, I can leave it where it's supposed to be.
Today wasn't a bad day. It was just so hectic. Thank God another nurse was orienting with me, so she could focus on passing meds and I could try to keep up with everything. We suspected one resident had an URI (green, pasty/sticky phlegm coming up every 30 seconds, low-grade temp...). I called the MD yesterday, he ordered antibiotics. Trouble is, this resident refused to take anything by mouth, food, water, and especially meds. (When I speak of residents spitting their meds all over me, she comes to mind). We check her blood sugar (noting she hasn't eaten in several days) and at first it's too high for the glucometer to read. Which means it's over 600. (Normal is between 70 and 120/130). I repeat the reading, and it's 599. Yikes. Time to call her doctor. He orders blood work...so I draw the blood, send it down, and once we get it back, realize her white blood cell count is pretty high. I faxed that to the doctor, and his nurse calls back, tells us this resident just bought an all-expense paid trip to the hospital. She just came back three weeks ago, after getting pumped full of antibiotics for a suspected UTI, and looked great for a while. Hopefully she'll feel better soon...
Another resident complained of leg pain. I rub Arnica gel on her muscles with no relief. I give her her PRN Percocet, and an hour later, the CNA comes to find me, telling me the resident isn't responding. Not something you want to hear from a CNA about a resident. I go over to her, and see that her eyes are open, but her pupils aren't following anything. The expression "The lights are on, but nobody's home?" I never saw someone who fit that expression as well as she did. I check her blood sugar. Nothing unusual. I check her oxygen saturation and other vitals. Fine. The LPN who's orienting today brought her dachshund. And this lady loves dogs. So I put the dog on her lap. Slowly, she lifts her hand up and pets the dog and smiles. She's fine, but to describe it, this resident looks stoned. I left a note for the doctor, wondering if she needs something less potent. The doctor takes her off her Zyprexa instead, so we'll see how she is the next couple of days (by the way, the resident who asked me to cover her daughter with a blanket...this was her).
I didn't realize how much responsibility this job is until lately. I hate making mistakes. I catch so many little mistakes, and sometimes it's just highlighting the MAR to point out that hey, this person gets 40mg of Lasix at 8am, and 80mg at noon, so that the right blister gets pulled and used. And I make mistakes, too. I hate making mistakes, but I learn my lesson so well from them. A resident on Coumadin got orders to re-draw his PT/INR on a date. I chart it in Meditech, put it in the MAR, and forgot to order the lab to be drawn by the lab. So the PT/INR goes undrawn for over a week. But now you can bet the first thing I do is put that PT/INR lab order in. I don't want to be that nurse that insists on running to the boss and showing every little mistake so and so made. I will if there is a genuine, obvious med error. The day I found out about the PT/INR mistake? I realized the evening nurse prior to me forgot to give two different residents their pain pills. I did let my boss know, and she told me that nurse wasn't comfortable working that unit, and was actually the nurse who oriented with me today to get to know the people better. Everyone makes mistakes...including me. We're only human. It's just how we can prevent them in the future. I would love to have a stamp to use on new doctor's orders. Faxed to Rx? Check. MAR changed? Check. DC'ed blisters pulled from med cart? Check. Nurses' note in Meditech? Check. New labs entered in Meditech? Check. New labs on calendar? Check. But for now, it is what it is. Until I can convince my boss that we really do need that stamp so things don't get lost in the process.
I applied for school, to get my LPN to RN. I think I missed the deadline by a few weeks, so I don't know if I can get in. But I think now would be better for me to get my RN, before I get married again, and have kids. I actually met someone who I can't wait to have kids with. And I can't believe the difference...But everything happens for a reason, and if I get in, I'll be happy. If not, I'll continue to work, gaining my experience, and try again next year.
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