The culture of nursing homes and assisted living facilities has shifted far away from the use of restraints; most places are restraint-free by law these days. The hospital is one of the only places I can imagine restraints remaining in use, and that is simply because of the acuity (how sick) our patients there are. They cannot afford to be pulling out the lines that are giving them IV antibiotics and blood transfusions, because without those things, they will die.
Even at the hospital, restraints are considered a last resort. They frequently utilize one-to-one 'sitters' to watch and maintain safety of very difficult patients. I was pulled from my regular duties to act as one last night, for a confused elderly person who would not stop climbing out of bed (and was a fall risk), pulling out lines, and removing their much-needed supplementary oxygen tubing. Even with me there, the patient was very agitated, and trying to literally climb over the furniture to get out of the bed. I was willing to let her get up, but she was so damn fast she was apt to get away before I could gather up all the things that were attached to her so I could ferry them along after her to prevent them from ripping out.
Finally the MD returned the page from the nurse, and ordered a small dose of an antipsychotic. It didn't stop the patient from trying to get up, it just calmed the patient down enough to stop physically shoving me out of the way, which was good enough.
This was one of those situations where I think that chemical restraints would be so much more effective than physical. My patient has such poor short-term memory that s/he would forget what I had said literally 20 seconds before. Putting someone like that in physical restraints is going to be a huge safety risk because they're still anxious and panicky and energetic, and will focus all of that onto getting out of the restraints one way or another.
Whereas a strong sedative seems highly appropriate and could allow this person the time to absorb their antibiotics, fluids, and oxygen in order to begin healing.
Unfortunately, I don't think we have a specific policy and protocol for chemical restraints the way we do for physical ones. I understand they're risky in terms of oversedation; you don't want to accidentally kill someone! But I wonder, if I were the physician getting paged in the middle of the night, whether I'd view the sedatives I'm prescribing as restraints or 'sleep aids' or what?
Showing posts with label night shift. Show all posts
Showing posts with label night shift. Show all posts
Tuesday, February 28, 2012
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 . . .
Hell.
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!
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!
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