It's Wrong! (A night shift perspective)

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What does it mean when we wake up a sleeping, elderly, demented woman at 0300 in order to place a catheter in her bladder for a UA? When the woman is yelling and can't possibly understand what is going on or why? When in reality she is dying anyway? What is the point of waking people up at 0600 in order to give them a medication such as Prilosec or Synthroid (Tylenol?) - then telling them to "go back to sleep"? (This is done because pharmacy recommends med given at least one hour prior to eating - eating is done at 0700 for the convenience of the kitchen staff.) Where is the sense in placing a frail, 90 year old in an uncomfortable twin sized bed with a plastic covered mattress, in a room with three other people in the same condition? How enjoyable is life when you are hooked up to a feeding tube and cannot taste food or lie flat to sleep because it will kill you? Why must we send a person who is peacefully dying to the ER to undergo some more torture before they finally pass? Why, why why? Where is the gentleness?

The families are not present to see these things - they want "everything done" for their residents - everything except for comfort and dignity and peace. The "corporation" and management only care about what is done on paper, how it will look to the "state", and how many dollars are coming in and also how they can cut staff to the bone to decrease costs and increase their own bonuses. The doctors and nurses must go along with the program in order to not be sued.

I've worked in long term care a long, long time and there is nothing that is right about it and it is all so wrong! I am obviously going crazy at this point and it is obviously time to retire from this madness. Tell me, geriatric nurses, how do you endure?

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Specializes in Peds, Med-Surg, Disaster Nsg, Parish Nsg.

Hello and welcome to the site! I moved your thread to the Geriatric Nurses forum where it should get more responses.

Thanks for posting this thought-provoking thread addressing some excellent points. What is the point of this type of "care" that results in unnecessary discomfort and agitation of frail elderly patients???? What has happened to compassionate care?

I agree that these types of practices are wrong.

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Your post states many of the reasons why some nurses reach their breaking point and decide to leave LTC jobs, never to return.

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I once had a family member ask me if her mother was close to dying. 90 years old, frail, yet, full code.... I said, "I'm not in a position to determine if someone is close to death." She said, "I know - it's up to God to decide when someone should die." I responded, "unfortunately, it's the DPOA who decides when a person is ready die."

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Specializes in Gerontology, Med surg, Home Health.

We would never wake someone up to catheterize them...ever.

Talk to the DPH about the ridiculous med times. We were cited once because we didn't give Prilosec when the manufacturer said we should. We are smarter about it now and get the doctor to write progress notes about resident choice. My residents don't have to eat at 7...breakfast is anytime they want.

We can only control what we can control....we can't control families or DPOAs or anyone else really. We can educate, re-educate, get social services involved, keep advocating for our residents.

That's why most of us stay. I can still make a difference in someone's life every day I go to work.

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Specializes in LTC,Hospice/palliative care,acute care.

We have a close relationship with several hospice/palliative care agencies. They have presented many hours of inservices to the staff. The physicians and nurses are a lot more comfortable talking about palliative and end of life care with the resident's and their family members and it is making a difference.Look at you policies and protocols,do you have a "comfort care "program? If not, you can make a difference.

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...and what you mentioned OP, is why a lot of us find LTC really, really depressing.

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I love your "rant." I agree with everything.

However I kind of understand a little why sometimes family takes an (obviously) dying loved one to the ER. Not that it makes it the right thing to do.

I picture them seeing their loved one gasping for breath or moaning or grimacing and looking uncomfortable. They feel awful and assume their loved one is in pain and want some one (medical person) to do something. So off to the ER.

Thank goodness for hospice care.

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I understand where your coming from completely........that being said. If the resident doesn't want to wake up for that Prilosec, I respect their right to refuse, chart it and if it happens repeatedly we as the MD to change the time to 11am. A lot of times things (strait cath for UA) can get pushed off to the night shift simply because "we have time" (we do!?!?! Lol) I just try and advocate for the resident always. I try and make them comfortable, and happy. I find a smile from a 90 year old that I helped put there one of the most rewarding experiences of my life ?

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Specializes in hospice.

Sixtyseven, have you considered a career change and working in hospice?

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Wow! I work nights in LTC, and this stuff resonates with me.

Waking up an elderly resident with dementia at 0300 to shove a tube up her urethra, because she might have a UTI??

BULL EXCREMENT!!!

I want to ask the geniuses who set this time up: Would YOU want a tube shoved up your urethra at 0300???

And I agree: The orders come in on days or evenings, and they set them up for NOC shift, because we supposedly have so much freaking time on our hands. Never mind that we have the SAME number of residents, but with less than HALF the staff. And NO management.

Although I admit, that last thing is an advantage sometimes! ;)

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Specializes in LTC,Hospice/palliative care,acute care.
Wow! I work nights in LTC, and this stuff resonates with me.

Waking up an elderly resident with dementia at 0300 to shove a tube up her urethra, because she might have a UTI??

BULL EXCREMENT!!!

I want to ask the geniuses who set this time up: Would YOU want a tube shoved up your urethra at 0300???

And I agree: The orders come in on days or evenings, and they set them up for NOC shift, because we supposedly have so much freaking time on our hands. Never mind that we have the SAME number of residents, but with less than HALF the staff. And NO management.

Although I admit, that last thing is an advantage sometimes! ;)

Our UA's are collected on 11 to 7 because the lab picks them up at 6am and they need to be as fresh as possible. Also, the resident is usually already in bed. Much easier for them-try undressing and fighting to put a LOL back in bed when she is up and good to go for the day.It's as much of an assault during the day.If you are fast and have the proper help you can get in and out before they are all the way awake.

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