A Nurse’s First Job

 Nursing Home: How can 2 words that connote caring and comfort combine to form my worst nightmare?

It was my first nursing job! I was so excited, and so very nervous. Part of me wishes I had  been able to skip over the nursing home and go straight into a hospital job in the first place. Part of me is glad that I didn’t.

It started with the decision to go to a very small liberal arts college for my BSN, and then choose to gain my license and practice in another state. The result: despite a great GPA, extracurricular involvement, a smattering of academic scholarships, and some athletic awards, I failed to land a coveted new-grad hospital job. After 300+ applications to 50+ hospitals, and an unholy number of rejection emails, I decided to stop beating my proverbially bruised head against proverbial brick. I do doth protest that I wasn’t a poor candidate. I just wasn’t the best. Also, in my heart of hearts I don’t think my obscure little college, named for an obscure Viking king, helped advance my cause. It’s novel name seemed to get more laughs at parties than any tangible employment connections.

In October 2013, I decided to lower the bar. I started applying to nursing homes and rehab centers, and received an offer within the week. So began my career as a nurse.

I learned many things in my nursing home year. The biggest takeaway: I do not ever want to live in a nursing home. I would not wish that on anyone I love. It isn’t that the staff doesn’t care – we often care very much. We work so hard to fill all of the roles that our residents require: wound nurse, pain consultant, respiratory therapist, companion, shower attendant, family liaison, and yes – even waitress. It’s just that we don’t really have the time to be an actual compassionate friend. Sadly, friendship and compassionate love are what old, injured, sick people seem to most desperately need.

Anyone who’s ever been injured knows that that relying on someone else to tend you gets old fast. Imagine having an itch between your shoulder blades that you aren’t able to reach – or God forbid, you desperately have to pee (or worse, poop), or are going to throw up but cannot get up to the bathroom without assistance, or you hurt. You ring the call bell, but there is only one nurse and one aide for 15 residents. Unfortunately, someone else is on the toilet, and facility policy forbids staff from leaving a resident unattended in the bathroom, lest they fall. The other staff member is assisting a resident to dress for dinner, and will be inaccessible for at least 5-10 more minutes. No one is in the hall or at the nurses’ station to hear your call.

Living in a nursing home will greatly increase the risk of you/your loved one having an incontinent episode. There will be times – especially during the ‘rush hours’ around waking and bedtime – when your call light will go unanswered for 20 minutes or more. Again, it’s not that the staff doesn’t care; there simply aren’t enough of us. We can get the work done, yes, but not in a way that consistently meets residents’ needs (and demands) when they are first brought to our attention.

I have a horrible memory of trying to explain to a wheelchair-bound 90 year-old woman that I couldn’t take her to the restroom because I wasn’t supposed to leave the dining area where 50 other residents were eating. After all, somebody might choke. Minutes passed, and every other employee in the building seemed to have vanished. Actually, they were probably already busy toileting other residents. I hate hate hate violating policies. It sounds dorky, but I’m a rule-follower to the core. I can’t help it – it’s deeply psychological, I’m sure. But I violated the policy to go sit a little old lady on the toilet and keep her company in the bathroom. Of course, when I got back to the dining room, 5 people were done eating and anxious to get back to their rooms, 2 wanted more ice cream, and another needed to use the bathroom. Le sigh. That’s just what nursing homes are like.

Let us say nothing of the incessant ringing of call bells, except that it haunts me.

Let us say nothing of the atrocity that such staffing ratios are not only standard, but also sometimes  much worse.

 

Rather, let’s focus on the fact that it doesn’t have to end this way. Fit and able in youth and middle age correlates to fit and able in old age. The difference between walking and using a wheelchair is that of night and day. Proper nutrition early on is protective against osteoporosis and the hip-fracture-death-sentence. It is the difference between successful toilet access, and diaper rash. It is a determining factor in type II diabetes, and the loss of extremities to the incessant march of diabetic necrosis. It’s what stands between you and institutionalized dinners every night for the rest of your fading life.

I repeat: it’s not that the staff doesn’t care – it’s that nursing homes are businesses (like Starbucks or your grocery store), where each customer has to wait his turn, and no one gets preferential treatment. The company employs the minimum number of staff that can get the job done. It makes good economic sense, and is a horrible practice.

So what to do, what to do? It’s never too late to get healthy and fit. Do it for your future self. Do it so your kids don’t have to convince you that you’re safer in a nursing home where there aren’t stairs to fall down. You want to be that spry old woman (or man) who carries her own groceries, and prances up and down stairs till the day she dies (a death completely unrelated to stairs). I think a lot of people get hung up on exercise and diets that they can’t commit to. In the grand scheme of things, it’s better to walk a mile if you don’t want to run it, rather than skipping altogether. If that’s not enough to convince you, stay tuned, for I have more stories to tell.

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