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It's Wrong! (A night shift perspective)

Geriatric   (14,421 Views | 71 Replies)

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withasmilelpn has 18 years experience and specializes in Rehab, LTC, Peds, Hospice.

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3-11 would work fine - Lab needs to pick up within 24 hours. No need for 11-7 to do.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

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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?

You're preaching to the choir here, Sixtyseven. Both my mother and my mother-in-law are in nursing homes. Mom has late-stage Alzheimer's -- she hasn't recognized family for at least 2-1/2 years and is at the "drooling and dozing" or "Screaming and crying" stage. Yet my sister wanted to send her to the hospital for a cardiac work-up when the nurses thought she was having chest pain. What would be the point to that? She wouldn't understand what was going on, wouldn't be able to cooperate with the restrictions from either a heart cath ("Keep your leg straight!") or cardiac surgery. ("Don't use your arms, Mrs. Alzheimer!" "You've got a catheter, so just go ahead and pee.")

The worst part of it is, my sister used to be a nurse (back in the early 80s.) She should "get it", and she doesn't.

Neither does my mother-in-law's family -- DH is a nurse, he does get it. But one sister is an X-ray tech and should have a somewhat better understanding, but doesn't seem to.

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31 Posts; 1,128 Profile Views

You're preaching to the choir here, Sixtyseven. Both my mother and my mother-in-law are in nursing homes. Mom has late-stage Alzheimer's -- she hasn't recognized family for at least 2-1/2 years and is at the "drooling and dozing" or "Screaming and crying" stage. Yet my sister wanted to send her to the hospital for a cardiac work-up when the nurses thought she was having chest pain. What would be the point to that? She wouldn't understand what was going on, wouldn't be able to cooperate with the restrictions from either a heart cath ("Keep your leg straight!") or cardiac surgery. ("Don't use your arms, Mrs. Alzheimer!" "You've got a catheter, so just go ahead and pee.")

The worst part of it is, my sister used to be a nurse (back in the early 80s.) She should "get it", and she doesn't.

Neither does my mother-in-law's family -- DH is a nurse, he does get it. But one sister is an X-ray tech and should have a somewhat better understanding, but doesn't seem to.

This is why many people recuse themselves from any role in a relative's care. It may look to the staff that they don't care, or that the family sees them as incompetent, but if you are dealing with a sibling who is threatening you with a lawyer and charges of neglact if you don't put a feeding tube in Mom, some people decide that they don't want that kind of drama in their life. As for nurses, it's best to chart with the jury in mind, thanks to ambulance chasers.

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1 Follower; 2 Articles; 5,682 Posts; 50,804 Profile Views

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.

And this is where I come in.

So we poke them to draw blood, stick a tube in their urethra to draw urine, prop them up to do x-rays, strap them down to do CT scans, put stickers on their fragile skin, and squeeze their arm every 30-60 minutes... all while laying on an uncomfortable gurney in a bright, loud place.

Then, if the family is really clueless, poor old granny may get to have people pulverize her ribs in a vain effort to "save" her.

More so when I did subacute care but even now I sometimes think, "What terrible thing did this person do to you that you choose for us to inflict so much upon them?"

Thank goodness for hospice care.

Having seen hospice up close and personal - and with experience in multiple emergency departments - all I can say is, Amen... and too bad it's such an underutilized approach to aging and end-of-life.

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332 Posts; 11,777 Profile Views

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.

And THAT'S why so many of us are always telling you that we want to come and work for you, CCM :D

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If she didn't have dementia when she got there she would have it from sleep deprivation. Poor thing!

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113 Posts; 6,586 Profile Views

If you are fast and have the proper help you can get in and out before they are all the way awake.

Whoa!

If you can cath somebody and not even wake them up, you're a better nurse than I am, Gunga Din!

Actually, you probably ARE a better nurse than I am.

I just don't see how even FLO could cath somebody without waking them up....

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352 Posts; 6,939 Profile Views

Whoa!

If you can cath somebody and not even wake them up, you're a better nurse than I am, Gunga Din!

Actually, you probably ARE a better nurse than I am.

I just don't see how even FLO could cath somebody without waking them up....

Lol teach me :-)

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113 Posts; 6,586 Profile Views

3-11 would work fine - Lab needs to pick up within 24 hours. No need for 11-7 to do.

Amen!

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CapeCodMermaid has 30 years experience as a RN and specializes in Gerontology, Med surg, Home Health.

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" Much easier for them-try undressing and fighting to put a LOL back in bed "

a LOL???? please don't be demeaning...she's not a LOL...she's a grandmom or a mom or a sister or a friend

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lifelearningrn has 4 years experience as a RN and specializes in School Nursing.

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" Much easier for them-try undressing and fighting to put a LOL back in bed "

a LOL???? please don't be demeaning...she's not a LOL...she's a grandmom or a mom or a sister or a friend

What is an "LOL"?

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itsmejuli specializes in Home Care.

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Little Old Lady

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