Homeostasis interruptus

I don't know if it's this way at every job, since being a nursing assistant is the only one I've had in the last few years that had coworkers. But it seems like the facilities I've worked at have little internal cycles; everything is calm and good, staffing is stable, we rarely work short. Then, for whatever reason, there's a period of upheaval, which usually SUCKS because it means we're frequently understaffed.

That's what's going on at my job right now. A few people have quit without notice in the last month (bizarre) and it affects all of us. Even though there are 3 shifts per day, it really is a 24-hour shift. So when I show up on evening shift, and one of my coworkers has already been there for hours to help out day shift who were short-staffed, it throws off our balance. Or when we arrive and get report that consists of "we were understaffed, so here are the things we didn't get done" followed by a long list of things we must catch up on immediately, it makes a difficult day. And I'm sure it's the same for the night shift as well.

Add to that the mixed blessing of training another new employee tonight (this is the 3rd new girl I've trained, but I think she'll stick, she's already been a CNA for 6 years) and you have a recipe for a really stressful evening. It's great having another set of hands to help get things done when you're training, but it can slow you down because you must verbalize what you're doing and slow down enough to explain and demonstrate everything. There's less of that with someone who's already experienced in the field but you still have to explain the residents' quirks and the facility policies and procedures.

Ugh.

Why can't people just stay at their jobs, or at least give 2 weeks notice if they won't??

Then again, you have a high-stress, high-difficulty job which pays little and requires little education. That sounds like a recipe for a lot of turnover, doesn't it?

I just have to hold on until the new folks are trained and settled in.

Promotion

My facility is fairly small, as assisted living facilities go. We've got just under 70 residents, and usually have 1 charge nurse on shift supervising 6 caregivers/aides who take care of approximately 10 residents per shift. During regular working hours we also have the Director of Nursing and a med-tech.

All told, we've got maybe 2-3 different charge nurses for each shift, and they just take turns, and have 2 med techs. One does M-F, one does Sat-Sunday.

That doesn't leave a lot of wiggle room for call-outs, so sometimes our charge nurses end up having to work a double, and this last weekend our Director of Nursing (DON) had to come in and work a med tech shift, which she didn't like doing since she also had to come be the charge nurse simultaneously. Oops! That means she had to do all the routine med passes, PLUS all the treatements and assessments PLUS all the charting by herself. Ouch.

Med techs/med aides are a fairly new position that mainly work just in nursing homes and assisted living facilities. They can hand out routine meds to people who are able to actually take them independently - meaning that I could hand them a little med cup, say "here's your medicine" and they could then take those pills. If they had to have them crushed and in applesauce, or they weren't able to comprehend that they're taking medication, the nurse has to administer it to them.

Med techs have to be trained, need to have a basic understanding of pharmacology (how drugs interact, what they do, when to give them vs. when to hold them) and be responsible enough to handle narcotics honestly and chart appropriately.

Our DON decided we need another med tech because right now there is no backup if one of our two gets sick or goes on vacation.

Normally she would advertise within the facility to see who might like to apply for it, but this time, at our meeting, she apologized for not doing so but said that she had one person in mind for the job for a while now and was glad that this person accepted the position. She'll be training the new med tech starting this week. The new med tech is ... ME!

That's right, guys, Polly is going to learn a lot of new skills, be paid a little more, get to wear cute scrubs for the first time, and get more responsibility!

This is huge for me. I'm really excited, proud, and nervous.

Med Tech Polly, coming soon!

More Project

I was so excited about my new food processor that I didn't think about where I'll keep it. So then I started googling "small kitchen organization blog" to get ideas. And I liked this one where they labeled where all their stuff is: "Near To Nothing.

But the thing is, my kitchen isn't all super-organized just yet. I live in a pretty small apartment, and my kitchen is very, very small. See?


I use a stepladder to reach the things that are up above the cabinets, especially the pots and pans. Unless Mr. Polly is home, and then he can usually reach them for me, because he's freakishly tall. Okay, not quite circus level, but he's 6'4". Our apartment ceilings are about 11 feet tall. So we did a lot of vertical storage.

So, from left to right in the above picture, here's where everything is:



and





And I forgot to really show it but the furthest left cabinet is my pantry with canned goods and pasta and stuff, plus a drawer with dish towels, a low cupboard with pot/pan lids, tupperware, and napkins. And it's a huge freaking mess right now.

So this is the "before" entry; anyone have brilliant suggestions for how I can get to "after

A Quickie: What are they saying at these churches?

A lot of my coworkers are very religious. I don't know if that's because a lot of Americans in general are, or a lot of healthcare workers, or just that there's some overlap between religious people and the type of people who want to work with Alzheimer's patients.

But the other night at work, another coworker asked me whether or not I go to church, and like always, I said no. Actually my favorite exchange on this topic was when a coworker said "Polly, you love the Lord, don't you?" and I responded with "Oh, no, I don't have one." But they've all been very surprised that I can manage to be nice/kind to both my coworkers and the old people we take care of while still being an atheist.

I guess it's a charming compliment that they like me so much they assume I must draw strength from the same place they do?

But to share an FYI for anyone of any religion that's reading this: No matter what you hear from your church or fellow churchgoers, atheists are nice too. We don't kick puppies. Shoot, I don't even eat animals! And I don't kick my old people either, I give them hugs. Whether or not someone is nice is kind of a crapshoot.

And atheists can be good people, too.

Project!

I think I've mentioned on my blog here before that I'm vegan - I have been for about 2 years. That means I do not eat animals (including fish or other sea creatures), milk/dairy, or eggs. When I first realized I needed to become vegan (when I found out about the horrible abuses on factory farms) I was PISSED. I didn't want to have to make all those changes, and I was afraid it was going to be really hard, and that I'd never eat out again, and that I would be deprived of good food. Turns out I was wrong, it's waaaaaaaaaaaay easier than I could have guessed, and I can eat out whenever I can afford to.

My Mom gave me an Amazon gift card for my birthday this year so I used it to buy a food processor and...

So exciting! I have and love Veganomicon, and I'm a big fan of cookbooks in general. Recently I've been trying to lose weight - we're playing The Biggest Loser at the GreatRep and the winner gets $3.50 per pound donated to their favorite charity in their name. So far I'm totally not winning. I've lost 2 pounds in 2 weeks. Shoot.

I've wanted a food processor for a while now since I love grated carrot salads and I have a bunch of raw food recipes that I've never tried to make because a blender really doesn't do everything a food processor does. But I got my big box of delights in the mail today, so look forward to some recipe reviews and hopefully I won't slice off any of my fingertips trying to learn how to use a food processor for the first time. When I nannied the family I worked for had one and I would look at that sumbitch and then just put it away in the cupboard because it was too intimidating.

Now I've got my own sumbitch and I'm gonna learn how to use it, too. And hopefully lose some more weight in the process. Wish me luck!

Tough to (not) say goodbye

One of my favorite residents died yesterday. Jenny was in her eighties, and often still fairly quick witted; she might be thinking her mother would be mad that Jenny was going to be late for dinner, but she could always come up with a quip that would surprise you and make you laugh. Jenny was the first resident at the GreatRep that I really felt was a friend of mine, and it's been painful watching her decline. Of course we all knew she was on hospice, and anyone with eyes could see how outrageous her edema (swelling due to water retention, usually just in the lower legs/feet but in extreme cases like Jenny's can go all the way up to the abdomen and eventually lungs). But Jenny had been sick for a long time, and was still her usual loving, funny self when I saw her on Friday.

This was one of those rare times when my weekend coincides with everyone else's, and I had Saturday and Sunday off.

Monday I arrived at work, and during report, the med tech let us know that Jenny had passed away about an hour before. Me and another coworker who hadn't known about this both burst into tears, and apparently everyone else had cried throughout the shift yesterday as they helped Jenny through her last hours.

We were all grateful she didn't linger too long once she was actively dying, because she was basically slowly drowning and it was very scary for her.

I miss her already. I miss my friend, and I wish I'd known how suddenly she began to die because I didn't get to say goodbye. I'm torn between wishing I had gone to say goodbye to her body before they took it, and realizing that doesn't matter because she wasn't in there anymore. Still, when we closed off the fire doors to give the people privacy to take Jenny out on the gurney, I was seized with an urge to run after them and pat her hand once more.

We were all lucky to have gotten to know Jenny, and I know she was ready to die, but it's still hard. It was hard two weeks ago when she kept asking me to kill her. It will be hard next week when a new lady moves into Jenny's room. I hope her family invites us to her service.

In Which I Get Judgemental

You know those things you think about people but you aren't supposed to say because it's mean/prejudiced/snotty etc.? That's what this is about.

I recently trained a new employee at the GreatRep, who seemed nice. She's CNA certified but hasn't worked as one before. However she was working as a caregiver at a group home for developmentally disabled adults. Lower volume/patient load than what we do at the GreatRep, but same basic principles plus she's been through the CNA course so she should already know the essentials from that. Seems like a reasonably good hire, is polite, reads and writes English well.

The first red flag for me was when she mentioned something about her home life; that she had been traveling around the world or something for a few years (the first few years of her son's life) and then finally came back because she fell in love with her high school non-sweetheart, and now they're engaged and living with her son's Father. Huh. I generally think one needs a pretty good reason not to be around for their child's first few years of life, and wanderlust doesn't really count in my book.

The second one was that she was complaining about her job at the group home and how the stress of combative residents there was triggering her PTSD (acquired when she was younger, not through serving in the armed forces but ostensibly by having an effed up childhood). Uh-oh. Our residents get combative, and even though they're mostly old ladies, they can be a little scary at times. Would this be a good fit for her?

Answer: nope. Apparently even though she quit her job at the group home and now only works part-time at the GreatRep, she was STILL calling off frequently, wanting to go home early, etc. That's such BULL! Our jobs are hard but do-able when we're fully staffed. Leaving your coworkers short-staffed for no good reason is totally rude and shady.

Then the other night she insisted she had such a bad back injury that she had to go home. Seriously? Even though you were sitting there talking to me like everything was fine and bustling around preparing your dinner? I don't buy it. I think that this girl has a crazy family and that made her crazy, and then she hasn't bucked up and gotten un-crazy. Which sucks, because she's a parent now. And instead of growing up and holding down a job, she is hoping to get disability or something after working part time for a few weeks. Ugh.

I know it's not kind to assume people are going to suck if they tell you they had a bad childhood or whatever, but here's the thing: if they've gotten over it enough to function well? They won't tell you right away. They'll be aware that doing so is inappropriate. People can come from chaos and turn out wonderfully, but those are the people you're surprised to find out were raised so horribly. The ones where you go "Oh, that all makes sense" are the ones who need to get their butts into therapy and figure their crap out.

Or at least not come work with me. Sheesh.

Dementia Facility FAQ's: What family members are probably wondering.

We've had a few tours come through the GreatRep lately, as well as out-of-town family members come into town to see some of our residents. It's interesting to see how people react to the place their first time, and it made me think about what they're probably wondering but don't ask. So here's my version of what you might like to know about a dementia facility, and my answers:

1. Doesn't it bother them to know they're locked in here?
Surprisingly, no. None of my residents have ever said anything like that to me, and very few are aware that they cannot exit certain doors without setting off the alarms. We have secure courtyards they can go outside in, and we just redirect them away from the front door if they're up there fussing with the keypad (it requires a keycode to open it without setting off the alarm). People with dementia are very inwardly focused, for the most part, and get more so the more their disease progresses. So our little world inside the facility is usually big enough for them. It helps that it has a circular part of the floor plan which is good for walking/pacing.

2. Why are all those people dozing in chairs? Why aren't they awake?
The most common answer is that most of them don't sleep all through the night. I just worked my first overnight shift at the GreatRep and was very surprised at how often I was informing people that no, it's still the middle of the night, and helping them back to bed. I figure that even the ones who can't get up and talk probably spend a good portion of their time in bed awake too, so they just kind of doze off whenever they're tired. They're on more of a 24-hour schedule, like a newborn. And yes, if they're hungry or thirsty in the night, we give them snacks.

3. Why is that lady making that noise/yelling for help/hitting that chair?
I don't know. Sometimes repeating the same words or phrase over and over is soothing for people with dementia, it's called perseveration. Unfortunately, sometimes that phrase is something hard to listen to, such as "help me help me help me" or "hurry up hurry up" or a repetitive action, like banging on whatever is in front of them. We try to mitigate, redirect, and keep them occupied with other things but there's nothing we can really do to make someone stop doing a behavior like that.

4. What about privacy? Won't you sometimes be doing some things in front of other residents? We had a family member complain this week because the podiatrist was in to do foot care, and was set up in a room at the end of the hall which isn't closed off from the hall. They thought it was inappropriate to do foot care out in the open. The thing is, you have to consider the logistics; sometimes there isn't enough space in each person's room to set up a podiatry station. Also, see #1 about the inward focus. Very few of the residents pay too much attention to what the other residents are doing for any long span of time. Some have friendships and stick together, but then they don't mind if their friend is present while their feet are being worked on. We don't change their clothes or use the restroom in front of others, and if they're getting a brief change in bed, their roomate is asleep/cannot see over to their side of the room plus it's still quite dark.

5. Why are you feeding them? Why are they incontinent?It just happens that way; over time, almost everyone become incontinent to some extent, and eventually they stop feeding themselves. That's why they're getting 24-hour care now. We use mechanical lifts called sit-to-stands so that we can still give everyone the chance to use the toilet, and whether they void on it or not is up to them. That's what the briefs are for. I think this is probably one of the biggest reasons I'd have a hard time keeping someone at home and caring for them myself. Everyone incontinent really should be changed approximately every 2 hours. I couldn't do that at home. We've got a full staff and we all get to go home and sleep between shifts, which is why we're able to do our jobs well. Having worked in this field and seen how hard it is, I think I would be totally willing to put myself or a loved one in a good care facility; I just don't see how it'd be feasible to do otherwise.

The Opposite of the Tooth Fairy

One of the things I was really excited about when I got my job at the GreatRep was that (although I don't have health insurance) I get dental insurance! I used to love going to the dentist when I was a kid and never had a cavity.

So I happily made an appointment for the first time in 8 or 9 years. Woohoo, I thought! I'll get a cleaning and be on my way. Plus the dentist I picked is kind of gimmicky and they give you a paraffin wax hand treatment and free tooth whitening if you're a new patient with them. It'd be nice! Like going to get a haircut, right?

I was wrong. So wrong.

They did x-rays, and then said I had 5 cavities. Oh no. I got scared.

Then they said they could fix all 4 little ones right then and there, and I wouldn't even need to be numbed. I relaxed and thought okay, this must not be any big deal.

Then I found myself with my jaw jacked open wide by a plastic tubey mouthguard that was sucking up all my spit, fighting off panic as the dentist drilled into my teeth and it smelled like something was burning and my only means of communication was to raise one of my stupid flippered hands (still sandwiched into giant oven mitt thingies because of the stupid paraffin wax). Raise my left hand if I'm not okay? OW! I wanted to raise my left middle finger.

Anyway, I got the damn slippers off my hands so I could at least give a thumbs up or down, and got some numbing something to help me make it through the end of Fire And Brimstone In My Mouth.

My God, no wonder people hate going to the dentist! I never understood until now. But I have to go back 2 more times this month. And get the muscle inside my mouth (the one that's just below where a labret piercing would go) cut and cauterized. Oh shoot. This is not the way I remember trips to the dentist, people. Everyone now has my sympathy. Everyone with and without teeth, bless your hearts, every single one of you.

And here's a visual of the labret piercing. Not mine, I don't have one. All I have is an about-to-be-slaughtered muscle behind there. Crap.

Maybe I can give the dentist one. With a dull needle.

Day 26: What Kind of Person Attracts You

I like people that are funny, silly, strong-willed, and knowledgeable. I quickly lose respect for anyone who's too much of a pansy or shows absolutely no interest in learning new things. And while I can like and enjoy someone without much of a sense of humor, I'd rather be around people that crack me up. It's also important to me that people I'm close to have a strong sense of right and wrong, and act accordingly.

This is a timely topic for me because I've been having conflict with a couple of my coworkers this month, which is new for me. One told me I'd hurt her feelings and the other told me to stop intimidating her. Crap. Obviously, it's time for me to work on my communication skills! I talked it over with Mr. Polly and practiced some better strategies.

Just to clarify, the two ladies I've had trouble with do tend to be tempermental, and the one who said to stop intimidating her speaks English as a second language. I hope she meant to say stop trying to tell her what to do, which would have made a lot more sense, given the misunderstanding that we had.

I'm not a total bitch at work (or anywhere else) as far as I know. Don't be scared to talk to me, people! I felt really awful about this and am working on it. But I do really prefer to hang out with and work with people that can take directness without getting upset. It's such a time-saver.

Too bad we don't get to choose our coworkers. I'm comforting myself with the knowledge that I can learn to talk to these ladies in a way they'll understand and that 75% of my coworkers tell me how delighted they are when we're assigned to the same wing/that they miss me when we're not.

Whew.

April Fools!

I'm amazingly bad at pranks. I like the idea of them and think they're funny but to date, my best (and only) prank I've played was writing a love letter from a garage to a house. And then putting it on the door of the garage, wherein a friend of mine lived. I dunno, it seemed funny at the time.

So for the last two weeks or so, I've been saying "Is this a prank? If I turned all the spices in the spice cupboard upside down?" and so on. Mostly my ideas have not been actual prank material, according to Mr. Polly. So I swore to prank him all day long today for April Fools' this year. In order, here are the pranks and results for this year (I'm thinking we better consider 2011 a warmup year):

1. Salted his toothbrush. He didn't notice.

2. Since he didn't notice the salt, I did it again with garlic powder. That he noticed before using it and washed it off first. Shoot.

3. Put a bunch of garlic powder in the lid of his shampoo bottle. Again, he didn't notice. This is becoming a theme.

4. Put a bulb of garlic in each of his shoes, because I figured I already had a theme going at this point. He noticed!

5. Pretended the TV remote didn't work at wouldn't let me push play for "Inside the Actor's Studio". He caught on right away, knowing that I can't handle that pompous James Lipton.

6. Went to our comic book store in the middle of the night and filled the little dorm-fridge with rolls of toilet paper so they would tumble out when he went to get a soda. Our business partner got to it first, and got a big kick out of it.

7. Changed the white board at our comic book store to say that the new management (Mr. Polly and our business partner) are now under new management, and drew a picture of them gazing lovingly at a winking Savage Dragon.

8. A long time ago I accidentally put the song "Iko Iko" on Mr. Polly's iTunes and he was really confused. So I put it on there over and over again under different playlist titles and then synced it so that was the only song on the whole iPod. HA! Unfortunately that bad man went to sync it before heading to work and discovered what I'd done. Luckily it was taking so long to put all his music back onto his iPod that when I offered to drop it off at the store later, he agreed. So I put Iko Iko back on! And got our business partner to cue it up when Mr. Polly walked in the door later. Success!!!

I have two more that I haven't done yet but I'm getting pretty tired. So April Fools' Day may have to last for two days this year. Suggestions welcome!