Day 03: My Views on Drugs and Alcohol.

I just worked a 12 hour day, so this will be short and not-so-sweet:

Drugs: YES. Halidol, Ativan, Antipsychotics, and anything that makes those combative residents stop BITING me (yes that really happened tonight).

Illegal Drugs: No thanks. I'll stick to my ibuprofen.

Alcohol: Rarely. I went through a phase when I was younger when I used to binge drink, which was not the greatest plan. Now I almost never drink at all, and stick to just one or two. Mr. Polly says I have the tolerance of an 11 year old.

True story: Just now I was telling Mr. what I'm writing about and now he's going to get us some Riesling. Because I ache from head to toe and because I got BITTEN BY A GROWN WOMAN! I think a glass of wine and some Jeopardy or Smallville sounds like a good way to end my day.

Day 02: Where You'd Like To Be In 10 Years.

In ten years, I'll be 38 years old.

I will be an RN and never ever going back to school again if I can help it. I don't know if I'll still want to work in geriatrics or not. Maybe I'll have had my fill of it by then. I'll be working in a facility I like, with a population that I love.

I hope to have had children by then. At least 2. Hopefully they'll be healthy and happy. I'm pretty sure I'll think they're the best kids in the world.

In ten years, my husband will be 41. I hope he'll be healthy and happy too, and that we'll laugh about how we used to marvel that people with Cystic Fibrosis could be fine and middle-aged. I think he'll be fine and middle-aged, and so will lots of other people with CF, by then. And it'll seem silly that 41 ever seemed "old" for someone with that disease.

We'll still have our Small Business, but it'll have grown a bit by then. We'll take days off and vacations, and I'll probably still go and clean the store after closing time a few times a month.

I'll still live in this town, because I LOVE this town and am never, ever leaving, ever again. I moved away once, and that turned out okay because I'm back now. But I won't move away again. This is my home.

It's not that big of a town. In ten years, I'll know 85% of the people that live here. I'll have my fingers in every metaphorical pie around here, and will make up more ridiculous small-town festivals and parades to fill in the gaps of when we're not having one. And since I'll know everyone, my festivals will happen easily. March of the Maracas and Mustaches? On it. Festival of Whole Grains? Sure. Book it for April. These really aren't that far-fetched if you're familiar with some of the real-life shenanigans this town puts on yearly. And I love that about it.

In 10 years, I'll be happy, just like I am now.

Day 01: Relationship.

I'm married, and very happily so. I met my husband a long time ago, way back when I was 19. We married when I was 23, which I was pretty surprised about, having never planned on getting married until I began dating him.

We laugh a lot. When we go to bed at the same time, we stay up too late talking and playing stupid games we make up on the spot, like "Holla Whatcha Call Me" (pretty self-explanatory) and other weird stuff, like the time I decided to tell him "The Scariest Story Ever Told" in a bad Russian accent (it was about a character named Black the Ukranian who was covered in fur like a monkey from hell). I wonder if our neighbors can hear us, and if they wish we'd just go to sleep for God's sake.

I still think my husband is very handsome. And he's still very tall. Even when we're old and he shrinks, he'll still be very tall. When you start out at 6'4" you can spare a little spinal compression.

Having been so young when I started dating him, we've really grown up together. Learned how to be responsible adults that show up for work on time and pay our bills on time. I've learned how to cook, though not 'till we'd already been married a while. But I'm good at it now! We've traveled together a little bit, but not that far away. When I was a nanny, the family I worked for took us both with them on their vacation to Whistler, BC, which was really fun. They have special trash cans there that are too confusing for bears to get into. Also, I taught my husband how to ride a bike.

When I was younger and my single female friends would ask me how to pick a guy, my basic advice was "Look around at everyone you know, and pick the guy that you think is too nice and funny and cute for you. Then ask him out. Or maneuver him into asking you out. Then try really hard to be good enough for him, and expect him to do the same for you. Then you'll be happy."

It worked for me!

Happy 9th anniversary this fall, Mr. Polly!




PS we both just figured out what we wanted to be when we grew up, like, a year ago. So don't stress about that either, people.

30 Days of Blog Topics

Just like Estelle Darling at www.brfirefly.blogspot.com I thought this 30 day blog challenge looked fun:



I'm not promising to cover all of these, but we'll see how it goes. It's always nice to have something besides work to write about. Especially since work has been kind of nuts lately; one of our residents just came back from the hospital after a stroke and is now a 2-3 person assist WITH a sit-to-stand (shudder). This is inconvenient, to say the least. Plus she's the first one to have actually broken my skin while being combative (with her fingernails). Thank God for coworkers and sanitizer. It's instinctual to get pissed when someone injures you, so I was very glad to be able to leave the room when that happened. Ugh.

Let's all cross our fingers that this week goes a little smoother!

Death, Extended, and Death, Interrupted.

In the 3 or so months I've been working at the GreatRep, 4 of my residents have died. Since I'm pretty new there, I haven't had a chance to form the long-term bonds with them that some of my coworkers have, so it hasn't affected me as deeply as it has for some of them.

This most recent one, Mr. 4, was the hardest for me personally. Partly because he and his wife were new to our facility and got there around the same time as I did. Partly because he went from being fine, to having a major health event and being sent out to the hospital, to coming home to us already on comfort care and ready to die. His family was pretty amazing; one of their adult children spent the night in the room with the parents the entire time. Mrs.4 really appreciated that, and I think it eased a lot of the burden on her. Mr.4 hung on for several days despite being NPO (nothing by mouth, including food or water). We turned him every 2 hours, kept him clean and comfortable, and his family watched him go through the whole process. Not just their children, but nieces and nephews, aunts and uncles, the whole gang was there.

Providing care to someone who's dying takes on a whole new dimension when their family is there, watching you, sometimes crying, sometimes joking, just trying to maintain some kind of life during that limbo. It really drives home how your patient had a whole entire life and millions of experiences before this one, and it makes it sad that they have to end this way, with a slow dragging towards death.

Mr. 4 passed peacefully, and before he went I promised him we would take good care of his wife. It's hard to know what to say to someone who's just been widowed. Mrs. 4 knows what happened, her memory is still fairly intact. It's hard to force myself to reach out to her when I'm afraid that saying Mr. 4's name will make her sad. But she's already sad, and she knows we all cared for him before he went. So I keep making myself check in on her, ask how she's feeling, and so on.

I thought dealing with the dying people would be the hard part, but it's their families that I ultimately feel sad for.

So it made it all the sweeter when I went to Jimmy's wife's birthday party today and found out that she is no longer on hospice care! Mrs. Jimmy has held on so much longer and stronger than anyone anticipated, and I'm so glad that Jimmy won't have to face that loss in the immediate future after all. I got to tell him jokes and give him hugs and kisses and watch him hold his grandkids while his wife opened her gifts and ate her cake. Pretty nice to see death get interrupted.

(for newer readers, I wrote about Jimmy back when I first started this blog, here: http://scrubsandcrocs.blogspot.com/2010/07/authenticity.html ; I don't work at his facility or care for him through HomeCare anymore, but I'm in touch with his family so they invited me and my husband to the party today - yay!)

Antipsychotic Drugs and Chemical Restraints

At the GreatRep, and pretty much all long term care or memory care facilities, there is a Bill of Rights list for all the residents posted prominently around the building. One of these rights is "to be free of all restraints, including chemical restraints". Logical, right?

As an aide, I have very little to do with the residents' medications. I report symptoms to the charge nurse, who then decides what to do from there. A few of the residents are on frequent doses of the same medications for certain behaviors or symptoms and so we all know what they will probably get in response to our reports of their symptoms. Lillian has severe pain and it's very obvious when it's not being controlled well, so when she hurts we all know she needs her Morphine. LuLu repetitively hits herself, which lets us know it's time for more Haldol or Ativan for her.


A lot of science news articles state that the use of antipsychotic drugs for dementia is a bad practice. It's not intuitive, because if you look at the list of symptoms of say, schizophrenia:
"They include disorganized thought processes and disorganized behavior as well as delusions and hallucinations. The disorganized thought processes are seen primarily in speech such as rambling and 'word salad'. The patient may babble about various different topics one after another, which to the normal person, do not appear to be connected in any way. The phrase 'word salad' describes a patient’s incoherent speech, which lacks correct grammar and any obvious purpose. Disorganized behavior will be discussed in a following section. Hallucinations are false perceptions; patients believe they can hear voices others can’t and sometimes see or feel things others don’t. Delusions are misinterpretations of events and their purpose such as when patients believe the CIA is plotting against them or that their psychiatrist is involved in an assignation attempt against them. Schizophrenics cannot be reasoned with over their delusions; reasoning and discussion leads to the patient’s mistrust and anger." (1)

All of that is very typical of dementia patients as well. You'd think since the symptoms are so similar that the treatments can be as well. But apparently not, since the use of antipsychotics in dementia patients increases their death risk, for reasons unknown(2).

To be clear, it seems like Doctors are warning against antipsychotics to control behavior that is merely "annoying" for caregivers such as wandering, agitation, uncooperativenesss, etc. For behavior that is truly dangerous for the patients or everyone around them (self-injury, extreme combativeness that can physically injure both caregivers and the patient, etc) I think it can still be merited.

Which is why when I read articles like this one, "Alzheimer's Therapy Focuses on Care: Giving Alzheimer's Patients their Way, Even Chocolate"(3) part of me gets really frustrated. It seems like outsiders and the media tend to think that some of the interventions we routinely do on our patients are for our own convenience, and therefore wrong. I loved that it explained about emotional states lasting longer than the patient's ability to recall or explain the reason for the emotion; however I would have liked to have seen a few more realistic examples of how this can be implemented. Things like when one of my widowed residents becomes anxious, thinking her husband is injured and missing, it's more productive to let her talk about that briefly, then steer the topic to her children, who are all alive and well. She calms down and gets happier as she tells us about what they were like when they were little, and shows us the quilt her daughter made her. That way, when the conversation ends, it ends on a happier note, which is more likely to stop her anxiety cycle about her husband. And of course there are the more conventional redirections like trying to get her involved in an activity or focused on something else.

I just hate the idea that we're somehow failing LuLu because sometimes medication is the only way to get her to stop hitting herself. You can redirect her, feed her, hold her hands gently, all sorts of things, but if she's in that mood she will not be deterred and it's not safe for her.

Patients have the right to refuse care, for example. But an incontinent person who refuses to be changed for 8+ hours isn't making a reasonable choice and is endangering themselves by hugely increasing their risk for a pressure ulcer. So sometimes we just have to force someone to let us perform very basic hygeine on them. And it sucks. And sometimes the only way to do that without anyone ending up seriously hurt is to premedicate them, and sometimes even that doesn't work. I wish there were a magic wand to make combative people cooperate when you're trying to help them.

But for all the caregivers and family members who read that article, I want to tell them that baby dolls and chocolate are a part of the answer, and can be good tools, but we need more solutions. And that even as a profession, caregiving is rarely "convenient"; that's not why we do this work. So please give your facility the benefit of the doubt and ask first before assuming they're chemically restraining people for no good reason. It's a last resort, but sometimes it's the only way.

And I don't know if it really belongs on any patient's Bill of Rights. Because the truth is, they do have the right not to be restrained unless they're hurting themselves or others and nothing else will stop them.


1. About schizophrenia http://healthpsych.psy.vanderbilt.edu/AntiPsychoticMeds.htm
2. Antipsychotics and death risk increase http://www.webmd.com/alzheimers/news/20080616/antipsychotics-for-dementia-up-death-risk
3. Giving Alzheimer's Patients Their Way http://www.nytimes.com/2011/01/01/health/01care.html?_r=2&pagewanted=1

What a Winkle

I absolutely love the weird conversations I have with my dementia residents, and there's one that pretty much always takes the cake. "Cookie" hallucinates and can be very difficult to deal with, but she's often very focused on wanting to see a doctor and wanting every person she sees to be a healthcare professional. So I usually address her as Ms. Oven instead of Cookie, and emphasize that I'm a nursing assistant rather than a caregiver in order to get her cooperation. I once had to wrestle a wet incontinence brief away from Cookie, who gave it up only when I told her I needed the sample for the Doctor. Gross.

Anyway, over the weeks, Cookie has come up with some good ones; telling me the Borg are trying to get her when I go to wake her up in the morning, hitting on the life-size dancing Santa that we had up at Christmas, telling my female coworker what a "gorgeous guy" she is.

The other day I went to get Cookie up out of her armchair to go use the bathroom, and she had a little stuffed animal sitting on her walker. "Look at my Baby!" she said, as I approached her, "Isn't he cute? What should I name him?"

Her stuffed animal was a little moose, so I said "How about Bullwinkle?"

Cookie blinked at me for a long moment, then said "He's from . . . where? He's a Winkle, you say? Is he a Winkle?"

I answered "I think he might be, what do you think?"

"Yes, probably. A Winkle."

Oh, Cookie!

I could go on Survivor

You might think that Nursing Assistant skills don't come in handy in real life. After all, it's not like I'm in the supermarket and someone yells out "Help! My Granny is sundowning! Someone convince her to take her pills NOW! " or like I'm winning big prizes on a game show for my speed & skill in changing adult incontinence briefs.

BUT.

If you (like some bloggers) live in a house that was built in the 1800's & then divided up into apartments, you might know how much it sucks to be without hot water. For a few days. In January.

BUT. If you had spent countless hours bathing old folks as fast as possible, including sponge baths/bed baths, you would (like this blogger!) be able to wash your hair super fast to minimize iciness. And would have the common sense to bundle up in jeans and a sweater and shampoo while leaning over the tub.

Then after drying hair completely, you might just microwave some water & get the rest of the way clean in under 2 minutes flat.

I tell you what, if I ever get homeless I'll be the cleanest one around my trashcan fire. I'm resourceful, like frickin' Batman.

P-P-Pollyface has a P-P-P-Plan

The other day I got to play that dancing game for the kinect at a friend's house, and it is SO FUN. But now I think everything in a Lady Gaga way, which is why the title of this entry is full of P-P-P's like P-P-P-Pokerface. I also have been saying scu-ruh-huh-huh-hubs instead of scrubs.

Anway, the point is I have a Plan. Remember how I said I needed to get my butt into school to be a nurse so that I don't have to work this hard for this little money for the rest of my life? Well, I'm registered.

First I'm going to finally go get my CNA Certification, which will get me a (tiny) raise at my current job, and make me qualified to work in a Skilled Nursing Facility if I decide to leave my current job for a different place. I'll also be qualified to work in a hospital but that's more of a pipe dream; most CNA's would like to work in one, but pretty much every CNA works in long term care instead.

Secondly, I did my admission to our local Community College for fall quarter of 2011 to start doing my prereqs. Yeah buddy! I'll keep working while I'm in school, of course, so I'll probably just do one class per quarter. We'll see. I need to get good grades in them so I can be admitted to that baccelaureate program I want to get into to convert my BA into a BSN. So if I want to be a Straight-A Polly, I should probably make sure I'm also Has Time To Sleep Polly.

Look at me, I'm bettering myself! Not buttering myself. Maybe if I buttered myself, I could join the Haus Of Gaga. But buttering myself wouldn't be vegan. Or pleasant.

Something other than work

Since I did that year-in-review quiz, I realized maybe I can occasionally mention something here that isn't related to elderly people or poop.

So here's one: the summer before last, I decided to learn how to surf. But I live in the Pacific Northwest, which means our ocean is very cold. So I worked a bunch of extra hours (this is when I was a nanny) and saved up, and signed up for surf camp at Surf Divas in La Jolla CA. I took 11 days off, and drove all the way down there, camped near San Diego, and surfed during the days. It was pretty awesome.

On my drive down, I stopped for lunch and saw the world's most amazing pinball machine.


I set up my tent

And spent my days like this (yep, I'm in this photo. I'm NOT the one in the instructor rashguard, sadly)


It was amazing and scary and one of the most fun things I've ever done. I didn't get good at it, but I did it enough to want to do it more.

When we first started learning, we were on the "inside" - closer to the shore, where the waves have already broken and the water is shallower. On the second or third day, we were ready to paddle out to the "outside" - past where the waves are breaking. To do this, you need to paddle really hard and strong to get through the "impact zone" where most of the waves are breaking. You don't want to spend much time there, so you try to power through it as fast as you can. Then you get to the outside where the waves are more like big sloping hills lifting you up and down as you bob around on your board. When you get lifted up you can see the shore, and it's so gorgeous and calm and peaceful out there. From there you try to catch the waves just as they're breaking and then you can ride them all the way to shore. When you get one, you go so fast it feels like you're flying. It's amazing.

Here's a wave diagram that may help you understand what I mean by inside and outside and impact zone. Where it shows a peaking wave, that's where you'd be catching the wave to take off on it. The breaking waves are the impact zone. Further out to sea is the outside, and closer to shore from the broken waves is the inside.


I've only gone once since then, back in my cold section of the Pacific. This last summer I was working too much to have time to get out to the coast. Hopefully next summer!

Matching Game

Here's a little game I like to call "I found what...WHERE?"

I'll tell you what I found, and you guess where I found it. It's a little like "find the saltine" on Scrubs except so far I haven't found any saltines anywhere unusual.

Let's play!

1. I found a flashlight.
a) In a cupboard.
b) In a garage.
c) In someone's underpants.

2. I found a pair of dentures.
a) In someone's mouth.
b) soaking in the appropriate cup with lid, labeled.
c) wrapped in a sock and in someone's pocket.
d) shoved down into a recliner.

3. I found a missing resident:
a) Sleeping in someone else's bed.
b) In the furnace control room.
c) trying to open the locked gate outside saying "Damn it!".

4. I found poop.
a) In someone's underwear.
b) Trailing from someone's bathroom to their bed.
c) On the shower floor.
d) Under someone's fingernails
e) In someone's mouth.

5. I found toothpaste.
a) on a toothbrush.
b) on the bathroom counter.
c) in someone's hair.

Keep in mind, this game is extra tricky because for some of these, every single option is true! My world is never boring. Or clean for very long.

Happy New Year!

Bathing the Reluctant: a How-To.

It's my first day off (finally!) after being on for 6 days in a row, so I'm predictably spending the day at home. On the couch, in the bed, or the bathtub. I plan to do laundry and roast some vegetables later, but that's about as enthusiastic as I'll get today. I'm Tired with a capital T.

So when I got a call from the HomeCare agency this afternoon (I'm still "on call" with them, though I've yet to actually go and work a shift for them since switching from regular employee to on-call) I screened it. And then was pleasantly surprised when it was a voicemail from the office staff saying that my former client Gary has recently begun refusing to bathe for his caregiver, the one that took over for me when I left. She wanted to know if I'd be willing for Gary's new caregiver to call me and talk it over with me to see if I could help. Sure!

So now I'm feeling like a (tired) Shower Expert. And wanting to share my super-important knowledge with the world. So if you've ever wondered "how the hell am I going to get that cranky old coot to take a shower?", this one's for you.

Step 1: Assess the need/reluctance:
Lots of elderly people don't like to bathe. They truly don't need to as often (2x a week is just fine - they have thin skin and tend to perspire less than younger folks, and dry out easily if you wash them too frequently). They hate being cold, don't want to get naked in front of anyone, are afraid of falling on a wet, slippery floor, and may have medical equipment (indwelling catheters, ostomy bags) that make showering a hassle. No wonder they say no when you ask them to go hop in. So think about it first; do they actually need one? If yes, do you need to shampoo their hair as well, or can you give them a shower cap and just wash their body, and shampoo their hair in a sink later? Figure out the bare minimum of what needs to happen today, so you know what you're willing to negotiate down to.

Step 2: Prepare.
Before you even mention the word shower to them, go get it set up. Heat up the bathroom so it's uncomfortably hot for you. Make sure their shower chair/stool is in there, as is their shampoo and everything else. Bring more towels than you think you'll need. If possible, put bathmats down from the toilet to the shower. Bring in the clothes you'll be dressing them in afterward.

Step 3: Approach.
Hopefully you already have gotten to know whoever it is you're trying to bathe, so you know what approach works for them. Some people hate surprises, so you really need to tell them ahead of time where you're going. Pitch it in a positive way, with a smile and enthusiasm, "Hey Betty! Guess what? Since today is your shower day, I went and got your bathroom all nice and warm for you, and pulled out that lavender soap you like! C'mon, let me show you what I did!". Others, it's a mistake to mention the word shower until they're already in the bathroom. I have several residents like this. For them, I just say "Let's go use the restroom" and walk them in there. Once they're seated on the toilet, I go ahead and remove their briefs, pants, shoes and socks (this is where the bathmats come in; no bare feet on cold floors). Then and only then do I say, "Okay, Bill, we've already got you halfway ready, which is great! Today is your shower day, so I've got the warm water running, and if you just walk along these mats to the shower, I'll help you get settled in and get all warmed up in there."

Step 4: Overcome resistance.
Once you've pitched the idea, you'll probably get some resistance. Common ones, and responses to them are things like

"I don't need a shower, I just took one"
"It's hard work being beautiful, isn't it?"
or "Time flies, doesn't it? Today is Tuesday, so it's been about a week since last time. It's going to feel so good to get that warm water on, isn't it?"

"Why are you in such a hurry to get me wet?"
"We're not in any hurry. But I want your skin to be clean and healthy, so we need to get you washed up for that to happen."

"I don't want to get in there! I don't want to get wet!"
"I know you don't always like it, but I set everything up really nicely for you today. I think you'll enjoy it. Give me 2 minutes to try it out, and if you don't like it, I'll help you get out and get dressed."

"I don't want my hair wet!"
"Okay, here's a shower cap"
or if that's not an option "Here's a dry cloth to hold over your eyes. I'll aim the water so it stays off your face."

If your patient has advanced dementia and can't really talk or be reasoned with, still set it up nicely, talk them through it in a positive way. They're likely to get combative when you start to undress them, so it might be best to get a buddy to come and help you get through that part as quickly as possible so they don't get any more riled up than they have to. It's fine to leave on socks, for example, if they really won't give them up. They'll want them off later once they're wet.

Step 5: Bathe.
Do whatever it is you promised to do. If you promised not to wet someone's hair, don't surprise them by suddenly hosing down their head. That's not nice. Get them settled on the shower chair, check the water temperature on your inner arm (above your gloves). Chances are, most elderly people will want their shower cooler than you'd take yours. Approximately body temperature. Have them check the temp with their hand first. If they're not able to do that and give you feedback, start at their feet and move up slowly, so they get a chance to acclimate before feeling the temperature on their chest or back. Have them help and participate as much as possible, even if that's only to hold a washcloth to (hopefully) stop them from punching you. Keep talking through what you're doing in a gentle voice "Okay, Sally, here's some warm water for your back. Now I'm going to wash your back with this cloth, and then we'll rinse off all the bubbles. Good! Next let's do your chest" etc. If they're freaking out, do it as fast as possible, and concentrate on armpits and pericare.

Step 6: Finish.
As soon as you turn that water off, cover them in towels as much as is possible. If they walk, put down a dry towel on top of the (closed) toilet lid and help them walk over to it and sit down. If they don't, wrap up their shoulders and back, drape one over their lap, and keep one to start drying their arms and legs. Get them dry, lotioned and dressed as quickly as you can. Usually once they realize you're putting clothes on and not off, they'll relax and help more.

Pat yourself on the back, wipe the sweat off your face, pick up the zillions of wet towels, and spray down that shower with bleach. You did it!

Money Money Honey

You know what sucks? The pay. I make less than a dollar above minimum wage. Let's let that sink in. I'm someone who spends 8 hours a day feeding, toileting, grooming, talking with, dressing, and ambulating people with dementia. I notice changes in condition and report them to my charge nurse. I make sure their oxygen is on and at the correct flow setting. I chat with their family members, and update them on how their loved one is doing.

Most of my coworkers are on food stamps or some other form of public assistance. All of the ones who are single parents are.

The average cost per resident at an Assisted Living facility in my state is a lot of money per month. Remember, I'm in the Pacific Northwest:



The place I work at is always at least 95% occupied. We provide really good care to our residents (and their family members). The management is fair and reasonable. But we make just above a poverty wage, depending on how many people are in our households.

If my husband didn't earn any money, we'd be screwed. A lot of my coworkers also clean houses or do one-on-one care as a second job.

I don't know what the solution is here. Obviously individual families can't afford to pay more rent for their loved ones. Medicare subsidizes some of our residents, but some are private pay.

I don't have a solution for the whole system, but for myself, it's to get my ass back in school. I have a BA in Psychology, but found that I really don't enjoy the type of work in that field that a BA qualifies me for - it's direct care with very difficult populations. Tried it out, hated it, was unhappy, and fled to childcare instead. Then we relocated and I started working with seniors and have really enjoyed that.

I recently found out that I can do an advanced baccalaureate program to convert my BA into a BSN in just 5 quarters. As long as I complete my prereqs at community college first and get good grades in those. HALLELUJAH! My backup plan will still be to go to a technical college and get my LPN, but for almost the same amount of time, I could get my BSN (Bachelor of Science in Nursing) and be qualified to be an RN.

So that's my big goal of 2011. Get into school. Take my prereqs that I'm missing (microbiology, anatomy and physiology with lab, etc.). Because as much as I love my job and the people I care for there, I don't want to get stuck being broke forever.

So I won't.