If you work at a nice one, there’s no reason not to work at a nursing home. I’ve heard the slams by non-nursing home nurses over the years that somehow nursing home nurses are the bottom of the barrel, but I’ve found this to be quite untrue. Different types of nursing require different skill sets, and nursing homes often deal with many specialties under one roof. There is always the physical maintenance of chronically ill and dependent (in some form) patients. The knowledge of medications is extensive. Nursing home nurses must be able to deal with psychiatric issues, and know the most effective ways of handling them. There are always the emergency issues that require adequate assessment to get the resident the proper level of care. Wound care is critical- from surgical wounds to superficial skin tears that are so common in fragile elderly skin. The nursing home nurse has to be very familiar with various hoses and tubes, and how to keep them functioning. And then, there are the family dynamic issues that can change on a dime with any one of the nursing home nurses’ typical 15-30 patients and their families. Time management is crucial.
Then there is the fun part of nursing homes. I’ve been fortunate to work at some great facilities over the years. My first job out of nursing school was at a facility where I’d done staff relief work as a CNA. When I started my nursing career there, I was the only RN educated person in the building most shifts I worked. The ADON (Assistant Director of Nurses) was there until 4-5 p.m. when I worked 3-11 p.m., but otherwise I was in charge- without a license. I was a GN (Graduate Nurse), and since I had access to an RN 24/7 it was kosher back in 1985 in Illinois. Now, I think that’s nuts. Fortunately, I’m not so stupid that I didn’t realize what I didn’t know, so was very good at asking questions. I was typically responsible for 30 heavy care and/or Medicare patients on 3-11 p.m. AND another 30 dementia patients when I worked 11 p.m.-7 a.m. – my actual shift. I did a lot of double shifts. That’s how things were done back then. I was 21 years old.
I mentioned ‘fun’. I had some very entertaining residents. Most were out to lunch in a very sweet way. Those were the days of ‘reality orientation’ which is actually quite cruel. It attempted to ‘make’ the demented person come back to the right year and place, and it might have lasted about 3 seconds, and then they were still confused and unhappy again. Things moved to ‘validation’ some years later (I started using it as the result of frustration… when in Rome…) which didn’t lie to the resident, but acknowledged where they were in their heads. They weren’t going to be ‘fixed’. Dementia is progressive. Let them be in 1954.
One of my little ladies wanted to call her mother every night before bed. This lady was about 89 years old, which in a generous ‘young’ estimation made her mother at least 107. Uh huh. I was still in reality orientation mode, and asked this lady how old her mother was. She gave me some age that was younger than she was. This wasn’t going well. I asked her how old she was. She gave me some number younger than what she said her mother was (well, at least she was keeping up with the story she was sticking to). This went on for about 2-3 minutes. Finally, I unplugged the phone, put it on the counter, and she called her mother, said “Thank you”, and went to bed. After that night, we bypassed the inquisition. She was happy.
Then there was this skinny little man who tooled around in his wheelchair wearing a hat with his name on it. Going by the nurses station counter, all I’d see is the hat scooting along on the other side . “Max” was toothless, clueless, and so sweet. He also had an irresistable dopey, toothless grin. He was about 5 foot 5 inches, and probably weighed 85 pounds dripping wet. And he was quite a character. One day, he came up to the station in his chair, and stopped. I saw the “Max” hat, parked in front of me. I heard his gravely, soft voice saying “Hey! I want a cigarette.” Max didn’t smoke. Hadn’t for decades. I told him “Hey, Max, you stopped smoking 30 years ago.” He replied “Oh yeah”, and left. We went through that routine often. Another night, all hell was breaking loose with numerous patients having to go to the hospital for various reasons. I had ambulance crews coming from all directions at various intervals. While I was waiting for another crew, I was on my way down the hall to see the sick resident when I saw Max walking towards me, naked as a newborn, with his catheter disconnected from the bag, swinging like a pendulum as he took each step. Max was about as stable on his feet as a greased pig on glass. The naked part was just not pretty, and with an ambulance crew now in the building and heading towards me, I had to get Max covered up (and keep him from falling on his tail). Too late. One of the ambulance guys looked at me in horror and said “Tell me we’re not here for him” (or something close). I told them which resident to get, and went to wrap Max in a sheet as I guided his skinny butt back to bed.
Another night, Max’s catheter was clogged, and no amount of irrigating it worked. I had standing orders to change out catheters as needed (we used a lot of catheters back then), but I couldn’t get the balloon deflated. This was a problem. The catheter was stuck. I could feel poor Max’s distended bladder against his skinny skin, and knew he had to be miserable. SO, I called the doctor and explained the situation. He told me I could send him to the ER to get it removed, or do the same thing at the nursing home that the ER would do. I was young and game for a new task, so asked what that involved. He told me that I needed to keep injecting air into the balloon port until the thing blew up. Uh huh. Alrighty then. Well, if that’s what the ER would do, it sure would save Max a trip to the ER, and me a lot of paperwork to just get it over with. I got a 60cc syringe with the proper tip, and went to work. The first 60 ccs went in with no change. Max wasn’t reacting, so I figured it wasn’t bothering him. The second 60ccs also went in with no change. I was getting nervous. The balloon was 30cc and already full of sterile water before I started in with the air. About halfway through the third syringeful of air, I heard a pop, Max went “Ooh”, and the catheter shot out of him like the bullet from a military assault rifle, shooting pee on the wall about 6 feet from where it was coming from… OK, well, that worked! I replaced the catheter, and Max went to sleep, much more comfortable. Now we have bladder scanners that would have told me how much ‘room’ I had before blowing up the bladder was a major concern.
Another resident in that facility was a former missionary. She was now way out to lunch, and had some big issues with her feet that made them look ‘clubbed’. Normally, she rode around in a wheelchair, but with her bedtime routine, she could walk to the bathroom with guidance, and get some exercise while she got set for bed. She’d go to the bathroom, wash her hands and face, and uncerimoniously hand her dentures to whoever was helping her. Then she’d toddle back to bed, climb in, sit bolt upright, and recite the 23rd Psalm. When she was done, she’d look towards the door (her vision wasn’t so great), salute, and say “Goodnight Everybody”, and lie down. Every night!
These are just a few examples from one place I worked. Yes, it was hard work. I had a lot of medications to pass, treatments to do, and paperwork (with a real pen and paper!) to get done on each shift. But the residents were great. Well, most of them. But if being there and taking care of them meant that even one or two felt better, that was worth something. I got a lot of great skills for a new grad. By the time I went to work in a hospital some 8 months later, I could deal with stuck tubes, time management, and brand-generic medication names with the best of them. I loved the nursing homes I worked in, because I worked in great facilities. Had I worked in a pit (and I’d seen some as an agency CNA), I’d feel differently- but I never made the choice to settle for those. 🙂