More Things Your Nurse Won't Tell You: Spring Fever in LTC Edition

**VivaLasViejas**, ASN, RN

This past month has been literally four and a half solid WEEKS of that kind of shift, leading me to formulate yet another list of thoughts that we nurses harbor, but would never utter........at least, not unless we find standing in an unemployment line rewarding:

1) "I'm sorry, but I'm responsible for 26 patients and you are NOT the most important, no matter what you or your family might think."

2) "Do you really believe that screaming my name, banging your bed control on the side rails, and flashing the call light on and off is going to make me stop in the middle of assessing a resident who's having a massive GI bleed to fetch you a glass of water/put on a fresh gown/straighten out your blankets/move your bedside table?"

3) This one's for administration: "Just because Mr. K and Ms. C are adults, it doesn't make them COMPETENT adults who can have a normal, ahem, relationship no matter how badly they think they want it. He's got dementia and can't walk, she's had three strokes and is paralyzed on one side......yeppers, that makes for safe sex. I've already had to write five incident reports on the two of them alone this past week. And the mental image of finding them on the floor nude, with Ms. C's face planted in a place that isn't meant for one's face, is one that will scar me for life. Thanks a lot."

4) Here's one for my aides: "I love and appreciate every one of you. And I do need you to report every variance in vital signs, every skin issue, every miniscule change in a resident's condition. But if I hear my name called one more time this shift, I'm going to change it........and I'm not going to tell you what it is."

5) For families: "I know you love your parent/grandparent/sibling/fill in the blank. I wish we could do more for him too---sit here with him and read to him, bring him flowers, fluff his pillow, bend his straw. But if you're going to come in every day and nitpick every single aspect of his care, PLEASE take him home and care for him yourself. Frankly, I'd love to see you try it, seeing as how he's totally dependent for all ADLs and you've never even helped to feed him in the three years he's been here........"

6) For activity directors and social workers: "For Pete's sake, enough with the Bingo already! Why not do something a little different for a change? The residents have been cooped up in this place all winter.......they need to get outdoors and see something besides these four walls. They need to smell some fresh air.......take in a little vitamin D........maybe even pick some flowers to brighten up their rooms. And if you don't get rid of that caterwauling church group that comes in once a week to mangle hymns for an entire hour, I'm gonna lose it!!"

7) For kitchen managers and staff: "I realize you're on a tight budget. All the departments are. But does that mean you can't serve anything that doesn't come out of a can? Or that looks, smells, and tastes like actual food? No wonder so many residents lose weight and have to drink nasty-tasting "health" shakes four times a day---if I had to live here, I'd drop the rest of my extra pounds in no time. And your teamwork is as bad as the food: if you've got time to get on the PA system and demand that the CNAs bring back the meal carts, you've got time to come down and pick them up yourselves so my staff can do their own jobs, instead of yours."

? For visitors: "Please understand that there may be another resident sharing the same room as the person you are visiting. It's generally considered bad form to park yourself in a folding chair in front of your resident's bed to watch TV and then remain there as nurses and aides stumble over you on their way to perform care tasks for the roommate. Thank you for moving your lard-butt only AFTER I ask you to do so."

9) For housekeeping staff: "Yes, you do need to come down and mop the floor after a massive Code Brown. Don't cop an attitude and say, 'it's not my job'. It's not ours, either, but after you go home for the day, guess who has to do it then?"

10) For RCMs: Those who can, do. Those who can't, become unit managers. I know.........I was an RCM myself, and my worst fear while employed thusly was of having to don scrubs and get out on the floor. Now that I've seen things from both sides, I can sympathize and even commiserate with my unit manager, but there are times when I would cheerfully wring her neck for forcing us to use a meal serve-out system that works just dandy on day shift when there is enough staff to handle two dining rooms and the hall, but doesn't translate well to evening shift when staffing is cut to the bone.

Me: "I can't staff both dining rooms on 3-11. We need two aides for the main dining room and one for the hall, because we have ten feeders. It doesn't compute."

RCM: "Well, day shift manages just fine."

Me: "But they have five CNAs, plus a feeder aide. We have three CNAs and no feeder aide. How can one person feed all ten feeders in the large dining room PLUS serve out meals, fetch drinks and so on for the others?"

RCM: "You and the med aide should be in there too."

Me: "The med aide is still passing pills, and I'm doing twelve blood sugars, plus insulins that can't be given until the meal actually arrives. Suppertime is also when the doctors call, the families call, the faxes come in......neither of us has time to set foot in the dining room unless there's a fight or someone chokes."

RCM: "Well, they don't seem to have that problem on day shift......."

Me: "Hmglmph" (or words to that effect).

Then she goes home for the night, and we do things MY way. ?