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.

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.

Ugh.

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!

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!

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!

Night Shift Polly, coming soon!

As I wrote about in "(Temporarily) Hanging up my Stethoscope", I've been job hunting since leaving my last AL facility.

I started my final shift there pretty sad, and I did get teary saying goodbye to one of my favorite residents: Miss Millie. Miss Millie moved in right when I started working at the facility, and came to Assisted Living following a leg amputation. I was the first one there to help her with a shower, and she told me how much she appreciated knowing she was safe and wouldn't fall, and that I made it a comfortable experience for her. She feels self-conscious about her leg, and was anxious about having anyone see it, but she said I never made her feel uncomfortable. Miss Millie is an absolute sweetheart, on the younger end, and was always a pleasure to take care of; she'd show me the cute little outfits she got for her grandbabies, joke around with me, and fill me in on all the updates from the days I wasn't there. I gave her my phone number, so hopefully Miss Millie and I can keep in touch; there aren't any rules against that now that I don't work at her residence anymore. Hooray!

That final shift, though, apart from my goodbye with Miss Millie? It really kind of sucked. The night shift girl who was supposed to be coming in called off, and the new Nurse I was working under that night is one of those million-mph-always-in-a-kerfluffle people, so she didn't get that handled with any speed. I ended up having to stay more than 2 hours late until a fill-in could come and take over. Ugh. So I was glad to be leaving by that time, let me tell you!

With my job hunt, I went to every AL facility in my county, except for 2 because I already had offers before I got to them. I went to locked dementia units, I went to big national chain retirement communities, and I went to a janky run-down nursing home. I didn't apply at many Skilled Nursing facilities because I'm still not certified, just registered, as a Nursing Assistant. So I'm unqualified for the very medical side of things.

By the end of my applications, I had 3 offers: one at a super-crummy place (to work 2night shifts/week in their Alzheimers unit), one at this ADORABLE memory care place close to home (any shift I want, day and night are full-time, evening isn't) and one at a Very Well Known memory care place that does a lot of continuing education courses (5 nights shifts/week).

I took the adorable one close to home, mainly because with my schedule, night shift is the only one I can do, and they have 4 on, 4 off, rather than 5 on, 2 off, like most places. If I can work 32 hours a week and get benefits, rather than 40, I'll do it. I still have my part-time job at the homecare agency, and I'm committed to them through October.

So what's so adorable about the one I took? Well, first of all, the lobby (where they do the activities) looks like a frickin' Children's Museum. It's so, so sweet. They have a good schedule of activities, and the facility is clean and doesn't smell like urine or anything. Secondly, I like the layout; two wings with 3 halls, so each caregiver has a max of 10 residents to care for. The dining rooms are small and homey, so you're not feeling like you're feeding people in an airplane hangar. They have a small kitchen where day and evening shift can take the residents to bake cookies or let them wash dishes (or play in the water pretending to wash dishes, whatever they're up for). And they have a little "nursery" room (people with severe dementia often enjoy playing with baby dolls because it's such an instinctual thing, and many of them had babies of their own, way back when, so it can bring them back to a pleasant time and be soothing).

I observed resident care, and family interactions when I was there, and was pleased by both. The staff seem to really know their residents, and to be organized about keeping their health information up-to-date. They spoke to the residents kindly, even when what they had to say was "Hang on a sec" and even the front desk receptionist was able to tell funny stories about individual residents to visiting family members, which shows good communication.

I start orientation at the Adorable place next week. I really hope it'll be a good fit for me and that I won't be kicking myself for choosing it over the Well Known Place. I'm 100% certain I made the right decision in saying no to the super janky, crummy one.

And as for the facility I just left? It's in a difficult state right now. The Head Honcho Man just "resigned" (read: got told to quit or be fired) after some of his stuff came to light. According to the gossip, he was doing shady business practices (accepting and keeping residents who were inappropriate for the care offered there) and having an affair with one of his employees. Which is how he met his current wife. At his last job. Where he also "resigned". Ouch.

So all in all, it looks like I got out just in time, and I'm very hopeful about my future in this eldercare world of ours.

Ma'am, I Am Tonight

A fair amount of my old folks are pretty religious. I've got one who talks about Jesus like they're locker room buddies ("I told Jesus he's gotta help the Mariners tonight, because that new manager is from the minor leagues!") as well as one who used to be a pastor. I've got many who have paintings of Jesus up in their apartments, or rosaries around their necks, or crosses above their doors. The very religious aren't shy about sharing it, and in general I find it pretty charming. They found a faith that works for them and makes them happy, and I'm glad for them.

The difference between old folks and younger Christians seems to be that the elderly ones assume that anyone who is kind to them, and helps them, and cares about them (all of which I try to do every day) must also share their faith. And the thing is, I don't. At all. I'm an atheist. A big old nonbeliever.

You can probably imagine that this causes some problems. And you're right.

I think of myself as pretty tolerant, and also pretty practical. So when my Most Confused Woman Ever was alone while her husband was in the hospital, I hunted around her house until I found something with the address of her baptist church on it. And I took her there. And I grabbed her minister so that he could get his flock on board with visiting this woman, bringing her groceries, and visiting her husband. Because they needed community and support, and if that meant I had to sit through a hateful gay-bashing sermon to get it for them, then that was a tradeoff I'm willing to make. It doesn't mean I enjoyed it, but I did it. And then I never went back. But it improved my old peoples' quality of life, which was my goal.

And my octogenarian who talks about Jesus like they're pals who like the same sports teams and would be great fishing buddies? When he tells me he prays for me every night, I thank him and give him a hug. Because he's thinking of me, and wants my life to be good, because, as he tells me, I'm a "nice nurse and a sweet girl". I'm not going to tell him to quit praying for me, or point out that his God is probably sick of hearing about me and wishes he'd pray for someone more worthy. I may be imagining God rolling his eyes and saying "Ugh, not that dumbass Polly again!", but my old man is sharing his heart with me that way and so I like it.

But it starts getting sticky when, like my ex-pastor, my residents ask me directly where I stand on all this. The other night as I was laying out clean clothes for that man to wear the next day and helping him get ready for bed, he said "You are so gentle and kind to an old man like me. I know that Jesus Christ must have touched your heart to make you this way. Do you believe in God?".

Eeek.

Lucky for me, this man has memory loss, so I've gotten to try out two approaches with him: honesty and lying.

Honesty was: "No, I don't believe in God and I'm not Christian. Thank you for saying you think Jesus has touched my heart and that I'm kind to you, because I know that is a big compliment from you and I'm grateful that you like having me around". Unfortunately, that led to him wanting to minister to me, which made me late for giving out snacks to the diabetics, which isn't good for them, and then also late for giving a bedtime shower which meant that lady had to stay up really late, and I got off work late as well. All in all, not practical, and not useful. I'm still not converted, and Mr. Pastor isn't any happier than he was when we started.

Which led me to lying. Just saying "Yes" when he asked me again, and "Good night and God bless". He went to bed happy, and I got to give care to everyone else on my list in a timely manner.

I think you can probably guess which approach I'll be sticking with from now on.

And if their God gets mad at me for being a faux-believer when I'm on shift, then I hope he reads this: God, sorry I lied about believing in you. But while you're busy taking care of those people's souls, I was busy brushing their teeth, bathing them, feeding them, and kissing them goodnight. You can understand that, can't you? They need that stuff too. So don't be mad. I'm just doing the best I can. And so are they. And according to them, so are you. So let's be friends, and I'll see you at Monday night football.

Maybe I should double-check with some of my old folks about whether or not God can read blogs. And whether or not caring for the sick and elderly makes me exempt from wrath or not. I'll figure it does until otherwise notified.