Friday, October 29, 2010

Choosing a Nursing Home Part 2

I did my last noc shift night before last, which means I have more time now again! In fact, my new job is split day/eve shift, but never both in one day, and I'll always have 2 days off in a row; isn't that called a weekend? I can't remember. It sounds heavenly though.

So now I have time to share my hard-learned lessons on choosing a nursing home to live or work in. I think they can be the same post, because if a nursing home is bad to work in, it's probably bad to live in. The reason residents are there is to get care, and if the employees are miserable, the care is going to be substandard. If the employees are happy, the residents are happy, and it creates a happy cycle.

I made some big mistakes on my last job hunt; I let schedule and pay dictate which facility I chose, and overlooked some red flags. I'm actually pretty embarrassed about that, but at least I can come clean here so any readers (hopefully) won't do the same things. I was just so focused on finding a job that would allow me to keep my homecare job that I chose the wrong facility. If I'd been willing to give up my security-blanket job at the homecare agency earlier, I think I'd have chosen differently. Oh well, here I am about to start at the GreatRep, so it all is for the best now!

Mistakes I made:
1. On my tour of the facility, I didn't insist on seeing into any of the resident rooms.
Realistically, this may not have saved me, because usually you don't get to see one that's currently occupied. The "model" room or apartment is usually empty and therefore looks perfect. But at the Crapdorable place, I had no idea that around 20% of the residents sleep on mattresses on the floor. It's for safety, to keep them from falling out of bed, which makes sense and all, but is incredibly hard on the caregiver's body that has to try to change their briefs and reposition them while kneeling on the ground next to them. This is why I was limping after each 4 day rotation there. The other reason to ask to see the rooms is to see what type of beds they have (if the facility provides them) and whether they're adjustable or appropriate for employee and resident safety.

2. I didn't ask the hard, slightly rude questions.
I did ask about aide to resident ratios, length of shifts, etc. But I didn't ask about how long management had been in place, whether there were any recent or upcoming changes there (new Executive Directors, new Administrators, etc). I didn't ask about their employee retention rate (20% at the Crapdorable place - huge red flag that I wish I'd known before I began there). I didn't ask about their call-out policy; if the answer is "you can't leave until the next shift arrives" this probably isn't a good place. Of course you can't leave, that's common sense that you cannot abandon patients. However, a good answer is "If there's a no-call no-show, your manager will find someone to come in, and will make sure the floor is covered in the interim". An excellent answer is "We provide an incentive for anyone who comes in on their day off so it's usually pretty easy to find coverage". A typical, reasonable (in my mind) policy is that if you call out, you must find your own replacement. The idea here is to discourage people from calling out hungover, or for other fishy reasons. Each employee gets a phone list, and usually if you're calling out for a real reason and have tried to find coverage and can't, a good manager will help you from there.

Another big question that's good for families AND employees to ask is "how full is your facility?" (aka what is your census like). If it's very nearly empty, proceed with caution. Sure, there's a recession, and more people are trying to make do with home care. But the good places will still be fairly full. Because locals have heard good things about them and prefer to put family there, rather than the sketchy ones. And if the answer is "lower than normal because of stop-admittance orders" RUN AWAY. Remember, that means they did something so bad they cannot allow new residents to move in for a set period of time. BAD.

3. Take a good look at the residents and employees you see during your tour. Do the residents look clean and kempt? Is their hair greasy, or is it combed pretty neatly. Do they themselves smell bad at all? Are their clothes weather appropriate and fairly clean? If it's a dementia facility, lower your standards a bit, because the residents often resist care, but still should get as much as possible. If they look visibly dirty, or unwashed, or their clothes obviously haven't been changed for days, this is a bad place. Now how about the employees? Are their uniforms clean? Is their hair reasonably done? Are they wearing inappropriate makeup? Do they look professional, or do they look like they should be smoking out back of a gas station? I know I'm judgemental here, but if the employees look trashy, it's a warning sign. If the employees look like they could be posted on it's not a great sign.

4. Lastly, smells. Any bad smells should be temporary. Or have a specific reason for them. If the entire place smells like old pee, it's because it's covered in old pee. The hallways absolutely shouldn't stink. Individual rooms sometimes might, especially if the resident living there has a habit of peeing on the floor (many do) or has frequent UTI's. Nonetheless, staff should be working on it to keep it to a minimum. A stinky place is probably not a clean place.

Saturday, October 23, 2010

Leaving my Blankie

I just realized that even though I told you all about leaving the Crapdorable place, I didn't say what I'm going to do instead! Duh.

My interview at the GreatRep place went very well, and they called back to offer me a job the same day. Even better, the position they offered me is one that I didn't know was available: full time, part dayshift, part evening shift (probably 2 days per week of each, one variable, 2 days off per week). That means NO MORE OVERNIGHTS!

And this time, let me tell you, I interviewed. I asked that administrator so many questions that I wish I'd asked at the Crapdorable place. Everything from "What's your employee retention rate?" to "What's the average census of your residents?" to "How long has the administrative staff been here? Any upcoming changes?". I'll explain all those in my next post about how to choose a nursing home, so if anyone reading that went "Huh?", don't worry.

I feel confident about the care the residents get at the GreatRep place, which means I'm very likely to be able to stay in my job there. Add to that the fact that I'm only working 5 days a week, and no more than 8 hours at a stretch, and I'm very likely to actually enjoy this job! It did, however, mean that I'm finally having to cut the apron strings and leave the Home Care Agency.

That place has been my only constant in the past year. I'm embarrassed to tell you how many other supplemental jobs I've had and left throughout my year at the Home Care Agency. Okay, fine: Four. About to start my Fifth. So leaving the Home Care Agency is me leaving my blankie, basically. But it was becoming a crutch, and preventing me from taking potentially great jobs that would have conflicted with my schedule there.

The GreatRep place has a scholarship program for nursing school. And if they ask you to come in on your day off, you get $2/hour more, which should translate into almost never working understaffed. They do a lot of things which mean members of the community come through all day every day, which makes it much less likely that anyone is being neglected; they're doing a fitness study with one of the State Universities. And they have a very, very cool program that I wish I could write about but it would give away which facility I'm talking about.

To make it more bittersweet, I just had my 1-year review at the Home Care Agency with Big Boss Betty (remember her from my first post here?), and it was awesome. They gave me a bonus equal to 25 hours of work, because that's what I've averaged for them over the past year. And they said I'm welcome back any time that I want. Awwwwww.

So I just have to get through my very last crapdorable rotation, then one week of only Home Care (should be easy as pie) and then I'll begin my new full time job at the GreatRep.


Thursday, October 21, 2010

Goodbye, Night Shift Polly

Just one rotation left at the night shift job at the Crapdorable facility, thank God. I'm giving my notice there first thing tomorrow morning.

What I learned/got out of my month on noc shift:

1. I hate working overnights. If I don't get enough sleep, I start randomly bursting into tears and just generally being a hot mess. Add a day job to that, and I'm sunk.

2. Noc shift is mostly changing briefs and toileting people that can walk. And redirecting wanderers. If the only good thing about it is "well at least I don't have to deal with crappy coworkers and management because I'm the only one here at night" then it's a bad job. Period.

3. Staying up working all night and then getting a little sleep and then working more? A good way to lose weight. I've lost another 5 lbs just during my first two rotations at the Crapdorable place. I told my husband this, and he said I should go back to Weight Watchers and share the good news, go up to the front and say "Here's what you do: get a bunch of old people ..." So if you think an overworked Polly would be a great new spokeswoman for the Nursing Home Overworked Diet, build me a website or something. I'll be happy to share all my tips with you.

4. Calluses. I already had some on my feet, but after being on my feet at least 8 hours out of every 24 for the past month, they grew freakishly fast. And my hands are effed as well. I started putting that really thick goopy Burts Bees stuff

on my hands every time I was going to get to sleep for 2+ hours and then putting socks over them to keep it on. Changing briefs all night, taking gloves on and off, and constant washing of my hands have made it hard to keep them from cracking and bleeding. And with the resident with the horrible skin condition, I want MY skin intact to keep whatever is plaguing her out of me. Way, way out of me. If I had what she has, I would be guzzling liquid morphine like it was gatorade. I feel so badly for this woman and I'm terrified of ever catching whatever it is she has.

5. If you want to work night shift, make that your only job. And come home after work, eat a meal, and sleep for at least 6 hours. And drink lots of water. And good luck to you.

I don't think I'll ever do it again.

Friday, October 15, 2010

I Bet on the Wrong Adorable Horse.

Remember how I was trying to decide between the Adorable place and the Well-Known place to work at next? And chose the Adorable one?

Looks like I chose wrong.

Today was the all staff meeting at the Adorable place, where they were introducing the new Executive Director. What I didn't know when I accepted the job is that the new Executive Director has been working there approximately 3 days longer than I have. And what I didn't know until this afternoon is that the nurse manager that hired me is now on a leave of absence after hiring 3 too many noc shift caregivers.

Also in the "things I didn't know" category: this facility has a 20 percent employee retention rate. When you end your shift, there's a decent chance that no one, or only a small portion of, the next shift staff will actually show up to relieve you.

The work itself is fine (if heavy) but not knowing if one can actually leave when you're supposed to? So not fine. I've been leaving anyway, because there's always a med tech on duty and they are charged with more responsibility, which means they cannot leave until they have someone to hand the keys to the med cart off to. I just say I have to go to my other job (whether that's true or not) and leave within 15 minutes of the end of my shift. And then don't answer my phone if they're calling to try to get me to come back.


Lucky for me, I got a call the other day from another dementia facility with a great reputation for an interview. It's also for a full-time, night shift caregiver position. The great reputation place is usually not hiring, but is the first one that people recommended to me when I started my search. I filled out an application, but didn't think much of it because they weren't hiring when I did so. I guess they are now! So I'll call them tomorrow and try to get in there to meet with them. I just really, really want one full time job with benefits that I can stay at long-term. The waitlist for nursing school is a year, and I'm not even on the list yet.

Maybe I should put a personal ad up on Monster:

Nursing Assistant/Caregiver Seeks ...
Assisted Living facility for gainful employment. Management must be willing to provide required training, and understand that gloves are not a luxury. Coworkers can say "ain't" and be trashy, as long as they actually show up for work on time. Facilities where residents have adjustable beds given preference, so this Polly doesn't have to mess up her knees and back trying to change people who sleep on the floor due to falls. If this sounds like you, contact me, Polly! I work hard, show up on time, don't call out sick, and will do extra things for my residents if the basics are already covered.

Alternately, I could stay at the Crapdorable place part time (2 shifts/week) while doing the 3 week CNA course and then reapply at the Skilled Nursing Facility of my dreams. Also a decent option, as long as I can continue to never, never get roped into staying when I'm not supposed to due to the flakiness of others.

Who Manages Nurses? Nurses.

After pumping myself up, studying my nursing assistant flashcards, and getting all dressed up fancy-like, I got to my interview at the Skilled Nursing facility only to find that in fact, they don't even consider candidates who aren't certified. Crap.

Since the facility is affiliated with a hospital, and the hospital is part of a multi-state network, they do all their applications online and have outsourced recruitment to a different company. This means that even though I applied online like I was supposed to, did my phone interview with the recruiter and did it well, it was only today that I actually spoke to anyone who knows about nursing. A nurse, and a nurse manager at that.

Oh well.

This is why nurses manage nurses. You know on TV shows how the doctors are always bossing around the nurses, telling them to do this and that? And sometimes even firing them or threatening to? It doesn't really work that way. Doctors and nurses are paralell professions that work together, but do not supervise one another except to serve as checks and balances against one another. Doctors are responsible for the health of the patients and so are nurses. If one staff does something wrong, it's the other one's job to catch the error and correct it. Sure, doctors make more money and are often more respected, but doctors are not the ones who hire and fire nurses. Nurse managers are.

So what happened today was a good example of why nurses hire other nurses (or nursing assistants): it's a complicated little world, nursing is, with tons of niches and jobs to fill. And non-nurses don't always know or understand all the distinctions between the various certifications.

And in Long Term Care (nursing homes, assisted living facilities, and the like)? You almost never see a doctor on premesis. Sure they come and assess patients occasionally, but for the most part, nurses do that. Nurses fax doctors to get meds and treatments ordered, and then once they get what they asked for back, they administer the treatment or med.

Have you heard the expression "Doctors diagnose, Nurses heal"?

Today it should have been "Human Resources interviews, Nurses hire".

Oh well, I'll be back with certification in hand by January. By the end of this month I'll have worked enough overtime to pay for a private CNA course out of pocket so that I can be finished in just 3 weeks, take the state exam, and get myself certified. Hooray!

Thursday, October 14, 2010

The Fury of the Little Old Lady

What I love about the generation that's old right now is the deeply ingrained sense of politeness and good language they have. There are exceptions, of course, especially when someone has dementia, but in general? Even when they are LIVID they don't tend to use curse words, and their expressions are antiquated enough to be funny and charming unintentionally.

I don't think the baby boomers are going to be that way. They'll be dropping f-bombs and the like, not exclaiming "Like FUN you will!" indignantly. And that's a shame.

One of my residents at the dementia facility is a perfect example of this cute-when-angry quality. Marla is in her late 80's and on hospice, but only recently became incontinent at night. Up until recently, she'd just use her call light to get up and go to the toilet when she needed to. So Marla is very, very unused to being changed in the night. And during the day, she gets Ativan and all the usual meds that help people remain compliant. But they wear off at night, so Marla gets feisty around 11pm. This means my rounds usually go like this:

I tiptoe into Marla's room, turn on her bathroom light so I can see, and say gently,
"Hi Marla, I need to check your undies, M'am, you can keep sleeing if you like"
I pull back the covers as little as possible and pat her crotch with my gloved hand, to see if her brief is wet or dry. 90% of the time it's wet. Shoot. I get a new one out, wipes, pull the trash can over to me, and ready a new incontinent pad.
"Marla honey, you're wet. We need to get you dried off so you'll stay nice and warm. These panties are wet. I'm going to take them off now."
(Marla groggily bats my hands away)
"Marla, sweetheart, I know you're tired but you're all wet. I'm getting you dry. It'll just take a minute."
(Marla wakes up all the way now, and oooooooh, she's not happy!)
"What in the HELL are you doing? Get outta here! Can't you let a body sleep? Go away! Get OUT!"
"Marla, I know you're tired, but you wet the bed, hon, so I'm getting you clean and dry."
"I did NOT! I've never done that in my LIFE!"
"Well somehow your underwear and blanket got wet, so you need new ones. You can just close your eyes, I'll do all the work and then let you get back to sleep."
"You are SICK! You people are sick! Quit taking off my pants all the time! Sick!"
"I'm sorry, Marla, we're halfway done now. Wet ones are off, I need you to roll towards the wall so we can pull up the new ones. Okay, I'm going to clean you with a wet wipe, there we go, okay, now one more big roll back towards me. Good. All done, you can go back to sleep now, thank you."
"You're sick. Don't come back."
"We'll see. Good night Marla."

The best was the time I forgot to bring a new incontinent pad to put under her, and said "I've got to get you a blanket, I'll be right back." Marla was angry to the Nth degree, and spat out "I WON'T miss you!" I know I shouldn't have, but I had to laugh at that one! How can you get mad at someone who says that to express their fury? It's adorable.

I do have one new resident who swears when I change him at night, but again, I can't take it personally. Warren starts out sounding fierce, but then drifts off again, sliding into "word salad" toward the end. So his tirades come out like "No no no no no ass BITCH get away bitch ass bitch no no no you can't you can't no fat bitch ass fuh fuh fiddle faddle diddle daddle doodle draddle . . ." and then he's out again. Starts out offensive, ends up silly. Every time.

And like every facility, there's that delightful 30% or so of little old ladies who are just sweet as pie no matter what. I wake them, ask if they need to get up and go to the bathroom, check their briefs, and usually get a hug and a kiss before leaving their room. It's pretty amazing. I really appreciate them, because I know I wouldn't be that sweet if someone woke me up every few hours every night of my life. But they seem to understand that I'm there to help them, and they love me for it. It's pretty great.

I like my old people at night, whether they're NOT missing me or giving me kisses for offering to help them to the bathroom. But that's not going to stop me from trying to rock my interview for evening shift at the skilled nursing facility!

Wednesday, October 13, 2010

Night Shift Polly, reporting for duty

As you might have gathered from my lack of posting, I started my night shift job. And boy did it kick my ass. Because I still have my daytime homecare job. Oops. This has led to me pretty much looking and feeling like . . . well . . .


I like the night shift job, though. It's definitely hard work, very physical, but by being there at night I can avoid any contact with management (often a plus at Assisted Living facilities where there's usually a conflict between nursing staff who want good care for residents and corporate management who want to cut costs). Also, I'm much more able to manage my own time - most of the residents are sleeping so while I must answer any call lights promptly, the rest of the timing is up to me.

During night shift, my work falls into 3 main categories:
1. Toileting and changing people, which is physically difficult and the hardest part of my job.
2. Cleaning and doing laundry, which I actually like doing.
3. Keeping an eye on the wanderers and trying to re-orient them and put them back to bed if possible (this is the dementia facility, remember?), which is the funniest part of my job by far.

The dementia facility is divided into two wings, each with 3 halls in them, and 8 rooms per hall. Some rooms are doubles, some are singles, and the whole facility isn't full right now. On night shift, each wing has one aide (me and this douchey guy that I'm so glad I don't have to actually see during work) and then there's a med tech there to give pain pills if needed, and cover our breaks, and clean the main areas of the building.

That means I'm responsible for about 30 residents during my shift, which sounds like a lot but in general is doable.

I arrive at 10pm and do quick rounds with evening staff, so that they can update me on all the residents, and if they didn't do their jobs, I have the chance to bully them into doing it before they can go home. More on that part later.

After they go, I read the shift reports, sign any care plan updates, and start my own rounds, changing and toileting everyone who needs it. This can take anywhere from 45 minutes to about 2 hours, depending on what state they're all in. Trying to change a fully grown person's diaper in bed when they are stiff and/or resisting isn't easy, and most of the residents have pull-up type briefs instead of side-tab, so there's a lot of rolling side-to-side involved. And frequently changing the waterproof pads underneath them. And occasionally, a full bedding change. Sheesh.

I do 3 rounds per shift, typically at 10:30pm, 2am, and 5am. In between rounds I do the laundry (sheets, towels, resident clothes), mop the dining room, fold the dining room linens and bibs, and answer call bells. It's enough to keep me pretty busy. If there's a really calm night, I may have the chance to sit and read for 15 minutes here and there, but mainly I'm up and moving the whole time. Which is good for keeping me awake all night long!

Ironically, as soon as I'd accepted the job at the dementia facility, the skilled nursing facility I've wanted to work at for MONTHS called me for an interview! I'm still not certified, or even in the course to get certified, but they have one wing I'm qualified for. So I go interview there tomorrow, and if they offer me the job I'll come up with a pro/con list between the skilled facility and the dementia facility to help me decide. I'll feel kind of stupid if I end up only working at the dementia one for 3 weeks, but like I've said before, there's massive turnover in this field so it's not like nurse managers are unused to it.

Wish me luck at my interview tomorrow!