"They treat us like mannequins", I hear this as I squeeze past two wheel-chair-bound women. They nod sagely, looking up at me eye brows raised with that certain tilt of the head, meaning 'yeah, she's one of them. What an odd thing to say I think, and it haunts me for days. Why do they feel like that?
A mannequin according to wiki, is "(also called a mannekin, mannikin, manikin, dummy, or lay figure) is often an articulated doll used by artists, tailors, dressmakers, and others especially to display or fit clothing.
Did these women feel like dolls? Did we simply dress them each day to our liking?
No, that's not what they meant...or this one, "A mannequin is a life-sized model of the human figure, used especially in advertising and sales. That's closer I thought, life size model of a human being. Something we notice, obliquely but don't really give the time of day to.
A mannequin has no soul, nothing behind it's painted on eyes. A mannequin is mostly...ignored. That's what they mean. We ignore them, treat them like a mannequin, dress them, feed them, move them around the nursing home on our own whims.
Go to PT, to OT, the dining room now. Go to the bathroom, sit down on the toilet, brush your teeth we order in bored voices.
As they do our bidding our own eyes glaze over staring into the distance, thinking about what's for our own dinner, our own plans, what we will do when are no longer here at work.
The mannequins, are wheeled down the hall while we talk, not to them but to each other, they aren't real why would we talk to them? That would be crazy--talking to a mannequin. It must seem to them that we don't SEE them. Their very humanity is obscured by their age in our young eyes.
We see gray hair, gray eyes, hear confused conversations, and forget this is NOT a mannequin. This is a real live person. Just like me--only old. Maybe even BETTER than me in some ways.
Mannequins don't age, they are forever young, beautiful, skinny and beautifully dressed. They never, ever change. Not one tiny bit.
People on the other hand are tall, short, fat, old, young, skinny, smelly, funny or angry. They act horrible or very kind. The differences are easy to see. So why are two old ladies made to feel unreal? The mind that thought that profound complex idea is most definitely alive, soulful, spiritual, and worthy of so much more than a clean set of clothes that get hung on them tomorrow, and a meal of ground pizza.
What can WE do about the lack of staff if the "manaement" does not act on our complaints?
If you look into the regulations to see what the actual staffing requirements are by law you would see that most facilities would meet the minimum's set and many would actually have more staff than is required. If your facility is not atleast meeting the regulated staffing requirements then you should point that out to them. Of course you might risk loosing your job for something like that. If you feel uncomfortable doing that remember every facility is regulated by a state agency (as well as federally).
The bigger picture is that the government is completely unrealistic in the money that is paid through medicare/medicaid for taking care of patients in LTC. There are going to be more cuts coming. Do some research into what your facility is given to take care of a patient. Then figure the total cost of taking care of that person and you would see why facilities are often staffed the way they are. We all need to redirect our efforts into letting those government officials know that we how unacceptable it is and that we expect more for our patients. Perhaps writing my elected officials and telling them how I feel and that changes need to be made will not make a difference but atleast you will know you have tried.
I work in an LTACH adjacent to a nursing home - and the difference in the way the patients are treated from one side to the other is astounding. I'm not sure what the reason for the difference is, though... Our aides are 1:9 and nurses are anywhere from 1:5 to 1:7. I pass my meds almost automatically, but - absent a couple of codes and a couple of admits - I also have time to talk to my patients, and that is exactly what I do. It's what the nurses and aides I work with do too. We round every two hours, not including meds, and if a patient is feeling 'lonely', they end up in their chair next to the nurses station.
I have had several patients who came from LTC comment on the difference while they're with us... I just didn't realize how different it was until I walked to, 'the other side'.
I think a lot of this has to do with a coping mechanism. Let's face it people generally enter LTC/Nursing Home to die. The people that work in these facilities are surrounded by death and they are afraid of getting too close to someone because they could die at any time. Reading this reminded me of something my grandfather said when I asked him if he had any buddies in the Army during WWII. He answered, "Nope, I didn't have friends in the Army because I didn't know when they might get their head blown off." Whether it is right or wrong to be like this is a different thread but . . .
meintheUSA: I appreciate your frustrations with being short staffed but unfortunately I think staffing shortages are a nursing issue in general not just in LTC facilities. As a person who has worked in LTC in management you should have some understanding for the reasoning behind all that staff. You know as well as I do of the incredible amount of state and federal regulations that they are bound to adhere to and the number of policies and procedures that are needed to maintain that facility within said regulations.
Many facilities have policies regarding employees being in the facility off the clock and I think this could be said about many employers not just those in the medical field. Of course there are reasons for this, I do not necessarily agree with them but I'm sure if we looked into their reasons for doing so they would be partially driven by liability and insurance issues.
I think all nurses can empathize with having to work beyond their normal realm of pace to get the job done. I think that there is this preconcieved notion sometimes by nurses that working in LTC is where you go to work when you want a slower pace, with less demands and responsibilities placed upon you. I can go work in the LTC down the street and pass out a few colace and some blood pressure medications and take care of some nice older folks and my job will be so much easier. Oh wait, you mean I have to give medications to 25 people today, redress 5 wounds, hang three GT feedings, 1 admission, send a patient to the hospital for a change in condition, take vital signs, perform assessments and documentation, monitor staff and do all that in 8 hours. No, its only 4 hours into your shift. You now have to figure out where "Henry's" hearing aids are. Henry dosent know because he cant remember he has dementia. So you search the room, and the trash can. You check with dietary and laundry and the other employees but noone has seen them. You go to the dirty linen room to check the trash but it has already been emptied. We have to find the hearing aids because Henry cant hear without them and the one thing he enjoys doing is going to listen to the music programs. So now you and a coworker go to the dumpster where you pull out bags of trash and rummage through all that you can possibly imagine and find Henry's hearing aids wrapped up in a tissue.
Now you can go back inside because its time for most of those 25 patients to get medications for the second time today. There are no code teams, no doctors in the building, when the fire alarm goes off due to a confused resident pulling it "because it said pull on it" you are one of the people responding with fire extingisher in hand. You take care of the confused, the combative, the debilitated, the lonely and the dieing. You do what you can to help them live what's left of their lives with the most comfort and dignity possible.
At the end of your shift you sit with with your patient and her daughter as her mother is dieing. You give what ever bit of emotional support you can give and make sure she is comfortable. Your patient takes her last breath with her daughter at her side. You try to do what you can to ease her daughter's pain. You tell her that she lived a full life and that she did all she could for her mother. I tell her that her mother helped bring her into this world and now she has helped her leave.
And you were short a CNA today and a nurse for the next shift has just called in sick...oh and wait I think I still need to pass out a colace.
So if you have tried to be part of the solution and it didn't work, try something else. Keep trying, for the good fights are never easy ones but they are usually the most important.
I work in long term care and its hard as hell. I do it because I moved to a small town with no hospital and now hospitals think I cant be retrained.. Hospital work even as a green RN was easier. You are everything in long term care and people do care about the residents and we do the best we can. My facility if you dont do good care they will fire you. The worst thing is the lateral violence between coworkers and I avoid alot of that by working night shift and no older persons dont sleep all night and they dont take Ambien as most sedative hypnotics dont agree with them... It brought tears to my eyes reading that LatRN thank you. It is how it really is and SCSTx yes ratios are everything and in LTC its for a RN or LPN 28 to 1 and then CNAs are 14 to 1 ratios and yes my state feels thats bare minimum staffing and another issue is they dont pay CNAs enough for what they do and how hard they work.
I do understand that some LTCs are this way, but I also know that some hospitals are this way. AT the LTC where I work, we feel as if our residents are family and it really is important to get to know each and every one. We know what they like to eat, their bath preferences and on and on. We do their hair and their makeup. Jus this past Friday, the last things I did before I left work, was I made certain that a gentleman resident's radio was on a specifc channel so that he could hear his balll game and I called my husband to bring me some sugar-free chocolate syrup to put in skim milk for a resident that wants us to assist him with weight loss, but likes chocolate ensures. Please know that each and every facility is different. There are caring nurses and CNAs in hospitals and LTCs everywhere!
Wow, thank you all for your comments and thoughts. I really love LTC and I do feel we are doing a service to people who are close to death. It's sad, it's backbreaking and it's frustrating. It's also rewarding and very sweet at times. The problems are with all of the 'supposed-to's' according to the state and facility that lead us to working the way we must rather than the way our hearts want to. Thanks again!
Its not just LTC facilities, I have also been a patient and treated like such in a hospital, upon discharge from a hospital with a serious injury i had a RX thrown in my face twice the transporter grabbed it the last time she threw it,( because i threw it back at her) yes i am a nurse maybe a bad patient but i have never treated people this way, EVER not to mention i was seriously misdiagnosed which could have prevented serious complications. People are hurt, upset , and desperate , there is no need to add insult to injury, better yet kick them when they are down, its sad. not only have i seen it but i have experienced it
calidonrnstudent, BSN, RN
26 Posts
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