You Got to Know When to Hold 'Em

... and when to fold 'em too. Nurses Announcements Archive Article

You Got to Know When to Hold 'Em

One of the few physical advantages of the over-50 body is its ability to say No to excesses---of food and drink, of stress, of too many long, hard shifts in a row. It's only when respecting those limits conflicts with the reality of nursing, where self-sacrifice is often the order of the day, that guilt rears its ugly little noggin and gives rise to the sort of discomfort I'm feeling right now.

I just came off a three-day stretch of shifts from The Bad Place that I can't even blame on a full moon. My LTC facility, which was scrambling to keep staff on only two weeks ago due to low census, is experiencing a huge influx of new admits; naturally, many of the nurses and aides whose hours were cut have taken other jobs or are on vacation, so getting staffing back up to accommodate our larger population has been dicey at best, and downright frightening at worst. On top of that, we've had a rash of UTIs on my unit recently, which makes life hell for all concerned: the affected residents tend to come completely off the spool and they start hallucinating, falling out of bed, howling at the moon, and generally freaking out. Loads of fun for all...especially the nurse who has to write an average of five incident reports in a given shift.

So it was with a great deal of relief that I pried my shoes from my screaming feet late last night, knowing I had two days off to recuperate before having to face it all again. Or so I thought.

The first call came around noon; since I have only a cell phone, I guard my privacy and don't answer if I don't recognize the number. I checked the voicemail; it was from my DNS, who must have been using her own cell phone or a private office number. Seems there'd been a call-in, and would I consider coming in to work if I could be assigned to my own unit?

Now, there are two schools of thought when it comes to phone calls from work on a nurse's off days. I've been in management, and I KNOW how hard it is to find staff on such short notice, and I used to hate it when I called staff and no one would call back. On the other hand, I'm not management anymore, and my time off is---or should be---mine to do with as I choose. Today, I chose to pretend my phone was off.

The second call came around four PM; this time it was one of the resident care managers, who sounded totally desperate. (I remember that feeling.) Turned out the call-in had come from the nurse who had been gone for over a month on one family emergency, returned during the low census and gotten her pick of shifts due to her seniority; now she had another family crisis and had to take off for parts unknown yet again...for how long, no one knows.

I'm probably going to Hell for this, but...at that point, I was no longer pretending the phone was off. I turned it off.

First of all, I'm sort of disgusted. I had to step aside and work a section I neither like nor am familiar with so this nurse could have my unit when she came back, even though I am the primary evening nurse for that unit. The residents, aides, and families were all unhappy about it, but none of that mattered because she had seniority.

Then there is the nine days' vacation I have coming up in less than a week, which I badly need to renew and refresh myself. I already know it's probably not going to happen without a fight. I also know that if I'd gone in tonight, they'd have pressured me to work tomorrow night and the Fourth of July as well. I'm scheduled for four shifts between now and the 6th, which would have made what, ten straight? I'm sorry, but I'm only good at what I do because I have adequate time away from it. I learned that lesson the hard way during that last management job. As it is, the past couple of weeks have been very difficult due to the fact that staffing in all areas of the building has not kept up with the increasing census; we are still doing housekeeping's AND dietary's jobs in addition to our own, and it's tough on everyone. I don't have time to set tables and bus trays when I have a dozen fingersticks and insulins to do before dinner, but I've done it and kept my feelings to myself because at least I have a job, right?

Well, here is where the old gray mare says "ENOUGH." I shouldn't have to postpone my vacation to accommodate the absence of the nurse who had to leave again. I'm also not going to work ten days straight or do doubles (the late-middle-aged body was never designed for 16-hour shifts in a nursing home). I'm already feeling the first faint stirrings of burnout as it is; floor nursing is tough at ANY age, and even though I enjoy my job most of the time, I really need a break. Since April, I've been looking forward to it, thinking "Only a couple more months...only a few more weeks...I can get through this, I've got vacation time coming up."

Yes, one has to know when to walk away, and when to run...even if the guilt is killing you and you fear the wrath of your bosses the next time you set foot in the building~

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VivaLasViejas

About VivaLasViejas, ASN, RN

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

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Specializes in Gerontological, cardiac, med-surg, peds.

Good for you, Viva. The only way to survive as a floor nurse is strict limit-setting and not feeling guilty about it! You need your days off to refresh. Keep that phone turned off :)

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Specializes in LTC, assisted living, med-surg, psych.

It's still off.;) In fact, I haven't turned the thing on all day........I have to go in soon enough (tomorrow) as it is.

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Specializes in psychiatric, UR analyst, fraud, DME,MedB.
It's still off.;) In fact, I haven't turned the thing on all day........I have to go in soon enough (tomorrow) as it is.

:yeah:Hi Viva, love your story, and yes , you do have to set limits, no matter where you work to be able to re charge. This guilty conscience is not a good thing in this area, since burn out starts this way.

I am thinking of changing direction of my career.... sounds like you have been a staff and management in LTC , and maybe you can give me an honest answer. I have been a UR , Medicare B, and DME medical review nurse and some short case mgmt.from a private hospital..... so, I have been away clinically, but will re learn and pick the skills up ....but there is also MDS in the LTC ???? I am willing to learn the skills again....but I hear so much undestaffed stories in this facility.......why is this? Is there no ratio to follow? You do not have to be an acute facility to follow the ratio, because you are still doing care, although not as emergent as in the acute hospital. I am trying to understand as to why this is such an issue in the LTC?

Thank you.:specs:

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Specializes in LTC, CPR instructor, First aid instructor..

I love your comment about the affected residents howling at the moon Marla. :yeah:You are so right though. Nursing is definitely difficult, and I feel only the ones who love nursing will be the survivors. Especially as we age.:up:

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Specializes in LTC, assisted living, med-surg, psych.
:yeah:Hi Viva, love your story, and yes , you do have to set limits, no matter where you work to be able to re charge. This guilty conscience is not a good thing in this area, since burn out starts this way.

I am thinking of changing direction of my career.... sounds like you have been a staff and management in LTC , and maybe you can give me an honest answer. I have been a UR , Medicare B, and DME medical review nurse and some short case mgmt.from a private hospital..... so, I have been away clinically, but will re learn and pick the skills up ....but there is also MDS in the LTC ???? I am willing to learn the skills again....but I hear so much undestaffed stories in this facility.......why is this? Is there no ratio to follow? You do not have to be an acute facility to follow the ratio, because you are still doing care, although not as emergent as in the acute hospital. I am trying to understand as to why this is such an issue in the LTC?

Thank you.:specs:

BTW, I AM on vacation.:smokin: They badly wanted me to work two more eve shifts, but I gritted my teeth and very politely said "No". I'm getting better at this.........I think.:icon_roll

Maritesa, I don't know how to advise you about LTC, because for every horror story one hears, there are probably a hundred wonderful tales that no one ever knows about because people don't pay attention to GOOD news. I won't deny that understaffing is a problem, because it is; there are ratios, but most of them were set back in the 1970s when the average nursing-home resident was still ambulatory and could manage at least part of their ADLs. LTC typically does not pay well when compared with the hospitals, yet we deal with all sorts of patients---dementia, psych, SCI etc.---that other facilities can't handle. We get hit, kicked, spit on, peed on, and worse. And the families can be, well, intense (to put it politely).

Yet most LTC nurses do this work, day after day, not because we can't find jobs anywhere else, but because we love this age group, personality quirks and all. As I type this I'm thinking of E.E., who pedals around my building in his wheelchair making announcements, much like a train conductor, at each nursing station; one time when I checked his ears, he ran around all evening calling out "Ear wax!" and grinning......well........from ear to ear! Then there's E.W., who cusses like a sailor when you give her her meds but then says "Oh, thank you, honey, you are a doll!" And S.M., who supposedly is in a 'persistent vegetative state' but always turns her head toward me when she hears my voice and laughs like a crazy woman when I get the hiccups.

Sheesh, I miss 'em already.........

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Specializes in med-surg, post-partum, ER, psychiatric.

Amen.........I work at a state psychiatric hospital.........it is so frustrating in that come nearly every Thursday of every week (and always on Fri/Sat/Sun) there are staffing issues. It NEVER EVER fails. Thereby, staff (on their days off) are called to come in an work because those scheduled become "sick" - you name it! The two years I have been at this hospital has been the same thing week after week after week. The Charge RN is always being asked by scheduling and/or the SSRNs to see if they could get their staff in to work or stay over to work an extra shift. Vice somebody holding these OTHER individuals accountable for constantly calling off during the weekends/holidays, WE pay for it overall....................I cannot tell you how many times I have had to work over and extra as a result. My unit is extremely stressful as it is then add to the stress of having to be "creative" in my staffing when I am not getting the required staff I need to have because.............................. I also used to check my work emails when I was off duty. I FINALLY put a stop to that in that I would just get further stressed out. If it wasn't our Unit Nursing Director sending out negative and sometimes "threatening" emails to us nurses, it was always something else to add to the stress we already incurred as a result of the very nature of this job. I have always scratched my head and even asked the WHYs of it all.........how can this be.....and why is it constant......and why does it continually happen........where is the accountability.................the consequences............and why are the non-core staff (the RNs/LPNs/psych techs in the acuity pool) NOT required to work the same minimum amount of weekends as the rest of us are required to work. Guaranteed that would reduce fairly significantly the issues we are faced weekly with staffing issues..............thereby placing pressure on staff who have already put in their time to come in and work more........................I am no spring chicken despite my military background and discipline of going above and beyond the "call of duty" and doing whatever it takes to "accomplish the mission" and get the job done!...............but I am feeling the end results of it these days...............staff are made to feel bad/guilty if they don't agree to work over or extra because OTHERS are not pulling their weight.................sheesh! I could go on and on and on..............the real puzzler is of late we have had all of these newly graduated/licensed RNs working in the pool now (along with LPNs), but the question still remains: What is happening on the weekends, and especially with all of these supposedly "new" people working the hospital now............and especially with the current economic situation...............during the first part of the week, per one of the SSRNs, nearly over-staffed..................hmmmmmmmmmm............doesn't take a rocket scientist to figure that one out and how to adapt, improvise, overcome..............make those necessary adjustments.........................but does that happen? oooooooooooooo noooooooooooo...we have deduced that way too many "promises" are being made and this is the end result. Bottom Line: Work the weekends like everybody else, pull your shifts as required, go find another job that will accomodate "them", be responsible, etc.........................then the rest of us will not have to work the OT, endure extra unnecessary stress, and so forth as a result...............Sometimes makes me wonder why I am in Nursing...............chuckles!

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Specializes in 6 years of ER fun, med/surg, blah, blah.

We are always told that we can't take care of anyone else, if we can't take care of ourselves. I try to remember that when I've worked over 50 hours in a week, because the money is good. The paycheck was nicely padded but I was beat. So what's more important here? And why do the nurses have to pay the price for being short staffed anyway? It's not our fault. I work in the ED & can across a great quote from the ENA magazine:

"Emergency nurses bear the brunt of overcrowing in the ED, even though they didn't cause the problem."

That can be adapted in a number of ways for which ever unit you do work on.

Good for you for taking care of yourself!

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Specializes in LTC, CPR instructor, First aid instructor..
BTW, I AM on vacation.:smokin: They badly wanted me to work two more eve shifts, but I gritted my teeth and very politely said "No". I'm getting better at this.........I think.:icon_roll

Maritesa, I don't know how to advise you about LTC, because for every horror story one hears, there are probably a hundred wonderful tales that no one ever knows about because people don't pay attention to GOOD news. I won't deny that understaffing is a problem, because it is; there are ratios, but most of them were set back in the 1970s when the average nursing-home resident was still ambulatory and could manage at least part of their ADLs. LTC typically does not pay well when compared with the hospitals, yet we deal with all sorts of patients---dementia, psych, SCI etc.---that other facilities can't handle. We get hit, kicked, spit on, peed on, and worse. And the families can be, well, intense (to put it politely).

Yet most LTC nurses do this work, day after day, not because we can't find jobs anywhere else, but because we love this age group, personality quirks and all. As I type this I'm thinking of E.E., who pedals around my building in his wheelchair making announcements, much like a train conductor, at each nursing station; one time when I checked his ears, he ran around all evening calling out "Ear wax!" and grinning......well........from ear to ear! Then there's E.W., who cusses like a sailor when you give her her meds but then says "Oh, thank you, honey, you are a doll!" And S.M., who supposedly is in a 'persistent vegetative state' but always turns her head toward me when she hears my voice and laughs like a crazy woman when I get the hiccups.

Sheesh, I miss 'em already.........

Don't ya just love them and their antics though Marla? I know I do. Especially the ones in the alzheimers unit. I get such a charge out of them.

One time when I was hospitalized, one came into my room (my roommate was sound asleep) naked as the day he was born. I asked him what he was looking for as he headed toward our bathroom. :D

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Specializes in psychiatric, UR analyst, fraud, DME,MedB.
BTW, I AM on vacation.:smokin: They badly wanted me to work two more eve shifts, but I gritted my teeth and very politely said "No". I'm getting better at this.........I think.:icon_roll

Maritesa, I don't know how to advise you about LTC, because for every horror story one hears, there are probably a hundred wonderful tales that no one ever knows about because people don't pay attention to GOOD news. I won't deny that understaffing is a problem, because it is; there are ratios, but most of them were set back in the 1970s when the average nursing-home resident was still ambulatory and could manage at least part of their ADLs. LTC typically does not pay well when compared with the hospitals, yet we deal with all sorts of patients---dementia, psych, SCI etc.---that other facilities can't handle. We get hit, kicked, spit on, peed on, and worse. And the families can be, well, intense (to put it politely).

Yet most LTC nurses do this work, day after day, not because we can't find jobs anywhere else, but because we love this age group, personality quirks and all. As I type this I'm thinking of E.E., who pedals around my building in his wheelchair making announcements, much like a train conductor, at each nursing station; one time when I checked his ears, he ran around all evening calling out "Ear wax!" and grinning......well........from ear to ear! Then there's E.W., who cusses like a sailor when you give her her meds but then says "Oh, thank you, honey, you are a doll!" And S.M., who supposedly is in a 'persistent vegetative state' but always turns her head toward me when she hears my voice and laughs like a crazy woman when I get the hiccups.

Sheesh, I miss 'em already.........

Dear Viva,

I took in your advice like a lost (not sure where to go) , frustrated/undecided ( feel like I could do better than where I am in my career), very thirsty ( searching) person out in the middle of the desert. your response put me in the proper perspective . Yes, I do love this age group, I also come from a culture that values their old people , so this will help as well, but your sharing of your experience w/ the quirks of each person helped me a lot. There is the good and the bad , and to embrace both is to conquer any indecisions....for me, anyway. Thank you so much!

I am not a young chick either , but I feel a strong nudge to go in this direction to play out the rest of my years in nursing. I will follow that nudge and will now get certifications in this area so that I may serve these population well with the best that I have . I love old people.....yes some can be nasty, but I will be too , if I am in the condition that they are in . thank you Viva. God bless you always. We need you sister :heartbeat!

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Specializes in psychiatric, UR analyst, fraud, DME,MedB.
Don't ya just love them and their antics though Marla? I know I do. Especially the ones in the alzheimers unit. I get such a charge out of them.

One time when I was hospitalized, one came into my room (my roommate was sound asleep) naked as the day he was born. I asked him what he was looking for as he headed toward our bathroom. :D

Hmmmmm, this is a good room . Good people and down to earth , no pretense. Love it ! thank you sisters! Much love and blessings to you special people ! :D:redbeathe

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Specializes in LTC, assisted living, med-surg, psych.
Don't ya just love them and their antics though Marla? I know I do. Especially the ones in the alzheimers unit. I get such a charge out of them.

One time when I was hospitalized, one came into my room (my roommate was sound asleep) naked as the day he was born. I asked him what he was looking for as he headed toward our bathroom. :D

:lol2:

We have a couple of gents who do that all the time, much to the chagrin of the female residents whose rooms they blunder into! I swear I spend half my shift chasing 'em out of other rooms---we don't have enough of those yellow door guards for every room in the building, and even where we do have them, the aides forget to put them up most of the time.:down:

Yep, I love these old folks.....especially, it seems, the ones who are the hardest to love. E.E.---he of "Ear Wax!" fame---is about as cuddly as a cactus on a normal day, and on a bad day he'll fight you to the death over using the lift or simply giving him some bowel care. But this crusty old soldier, who was in the Battle of the Bulge and got frostbitten feet for his efforts, happens to be one of my favorite residents.....and over the months I've worked with him, he's become almost affectionate with me.

One night, I was checking his blood sugar when he looked up at me and said, "You know, I've been widowed for a long time. I need to find me a woman."

I chuckled and said, "Well, there are a lot of them here, you've pretty much got your pick."

He shook his head, and his eyes began to dance mischievously. "Ah, I think you'd do."

I laughed and said, "Well, thank you, but I think my husband would have a bit of a problem with that. Besides, you don't want an old bag like me---you probably want somebody a little younger."

He grinned: "Honey, I'll take any bag I can get these days!":lol2::lol2::lol2:

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