Cobweb

I have an incoming problem. I have a half-time position, a desk job, which probably will soon be going to full-time. That's a pretty big load for me. There's no possibility of working at home or getting help. I have lupus. I'm a year post-cancer surgery. I had a fall with a brain injury which sort of killed my ability to sleep. I sleep in 2-3 hour blocks right now, which is a vast improvement over the past. I've tried about everything to sleep at night--no good--although cognitive behavior therapy helped somewhat, also daylight therapy and playing music :) I use a wheelchair. I exercise every day and eat a pretty good diet. What are some tactics I could use to help combat fatigue? Right now, I work 6 hours (have to add about 2 hours in there for drive time, loading and unloading my wheelchair, etc), go home and sleep 3 hours, get up and exercise, eat supper, and take my bath, go back to bed and sleep 3-4 hours, back to work.

I can't even achieve a fall rate of zero on myself ;p I used to get pulled to psych a lot and they had patients 1:1 fall all the time. I myself saw a big guy tear up a steel bedframe, shred 4-point leather restraints, escape 5 aides, and fall on the floor. I don't think zero can be achieved.

A friend of mine recently had to put her mom in the nursing home. Now, a couple of things she told me had me raising my eyebrows. She said they weren't allowed to bring her mom's own wheelchair in--that the facility required her to use the facility wheelchair, as they couldn't be responsible for patient wheelchairs. The facility wheelchair is pretty uncomfortable, where the lady's own wheelchair is a lot better for her bad back. I just never heard of such a thing. The other thing that confuzzled me is that the staff is not allowed to walk the patients. Only PT is allowed to walk patients, and since that is about $500 a week, that doesn't happen very often. Back in my nursing home days (when dinosaurs walked the land), nurses and CNAs walked all the patients if they were able. In fact, we had special restorative aides and so on. What do you think of that?

No, I flatly refused the patient, as they would have had an unsafe environment, and casually reminded them that state was coming pretty soon and did they want patients to be telling stuff like that to the inspectors?

We ran out of beds once. We had open rooms, just no beds to put in them. I had one electric bed shoved out in the hall and the unnamed management person was yelling at me, "Why don't you use that one?" "Because it caught on fire when the patient raised it up!" (It shot sparks out of the motor underneath the bed.) She said, swear to God, "Well can't you just take off the controller so they can't raise or lower it?" Even though we were missing three beds, they kept admitting people to the rooms.

We have a lot of ingrained behaviors, though, that we don't really think about. For instance, in one facility, when they banned the housekeepers and laundry people from speaking Spanish in front of patients, I banned people from speaking English in front of my deaf patients. I wish you could have seen the looks I got! It was hilarious. I explained that it was just about the same thing, but some folks just don't get it.

One time I was transferring an elderly gentleman to his wheelchair. He would go where you steered him, but didn't speak, or look you in the eye, or register people in any way. I had been taking care of him for over a month, and never saw one sign of mental life. As I was talking to him (telling him some dumb story or something), all of a sudden, he looked me in the eye, smiled a tiny bit, and patted me on the shoulder. Then he was gone again. But for just a brief moment, I saw the human being in there. It was pretty inspiring to me. Since that time I have always tried to remember that the meatsacks we are working on are really people :) It's easy to forget sometimes.

Thanks, guys, I didn't even know you could ask for an OT consult. And thanks for the tip about the wipes; I've never used them and the last thing I am gonna need is a stopped-up toilet, hehe :)

I don't have a good answer for you, but I can tell you what one friend of mine did. She studied the whole program ahead of time. She devoured nursing books like I read trashy romances. Then, when she did go to school, she already knew most of the stuff and had very little studying to do. She said it was the only way she could work and go to school at the same time.

Think of it this way--if everybody who was horrified by what happened to this family was not able to take care of the little girl, what would happen to her? She'd be surrounded by people who didn't give a damn. It is perfectly normal to have those feelings, and to have to learn how to deal with them. I went to the hospital morgue with my teacher when I was in school--lo, these many moons ago. The attendant was flopping around this baby on the slab like an old dead chicken. He was trying to get a rise of the two big cops standing there, I think. Anyway, I kept a stiff upper lip so as not to embarrass my teacher, but when we left I started crying. I said, "I guess I have to get used to things like that. I reckon I'll have to get tough enough not to care about that." She said, "If you get tough enough to not care, then you will be in the wrong profession." That was one of the moments that helped define my whole life--not just my career.

That's right, I'm gonna be on the other side of the bedpan ;p I am gonna have a pretty big operation next week, and am I worried about chemo? Nah. What about radiation? No. What about blood clots or dying? Newp. The thing that has me in a stew is...that's right, you guessed it...how does an old fat gal who's nearly cut in half wash her personal area? Let alone wiping after going to the bathroom. oh, vanity, vanity... Who's got some cool and groovy tips for me? I probably won't be able to bend much or twist at all. I'm getting all my hair cut off tomorrow so I can wash it with a washrag. I should throw in, probably, that i am a wheelchair user. I can stand on 2 legs for a bit, but standing on one leg probably isn't gonna happen. I found some flushable wipes that might be useful. I already stocked my freezer and fridge with food that doesn't require anything but a minute of microwaving. I have a big bag of yarn, a big sack of books, and a big list of TV shows and movies, all acquired for me by my son, possibly the most wonderful human being in the world, in my honest, clear-sighted, and objective opinion. I'll take all the advice I can get!

Speaking as a disabled person (and I'm not even a spinal cord patient), I wonder if they have considered how hideously uncomfortable it could be for your relative. If it is like the campground here, there's no hot water to bathe her with. She may have her chair to sit in, but where's she going to lie down? Have they considered that she'll have to be moved AT LEAST every 2 hours (every half hour for me). What about if the weather turns? What if it is too hot and sunny? What if it rains? What if it gets too cold? (And people who don't get outside very often have very little temperature change tolerance). What will they do if their equipment breaks down? (My brand-new wheelchair lift and my brand-new powerchair have died 2 times apiece just this year) Can they fix food that she can eat? I guarantee that after nursing home food, barbecue ribs or greasy hamburgers can run through her like grass through a goose, not to mention salt...I would not take her until I had a trial run, like a day trip to somebody's back yard first.

I just wanted to mention a couple of things that I don't think have been thrown in yet. Some people have little dinky arms and some people have great big arms--they won't measure well on "Nurse Nancy," even with the special cuffs. People who have very low BPs and very high BPs won't measure right. However, the night when you have to do 40 sets of vitals (which I have), you'll be thanking God for Nurse Nancy because after you pump up that cuff about 20 times, your fingers will never want to straighten out again ;p

Dear Allnurses: I will recap as briefly as a gabby old lady can :) I have to thank all of you for your support, through posts and private messages. Last year I lifted weights and didn't really feel like it was helping me. My son suggested I try walking in the pool at the gym, so I gave it a shot. I started in January. I am pretty excited to tell you that, after 10 years in a wheelchair, more or less, I am now **drumroll** **FANFARE** ----WALKING---- I am walking at work. I have left my powerchair at home the last 3 weeks. I still need it for any appreciable distance. but I can make it about 100 feet with just my walker, or I use a rollator and sit every little bit if I have to go farther. I just wanted to share that because other people's stories on here have helped me so much, so I hope this helps somebody. Doctors have never helped me feel better--it's other patients (particularly nurse patients) who have helped me make a better life.

I've been diagnosed with lupus almost 25 years. I love nursing, but you do have to take care of yourself. Nurses tend to be pretty co-dependent, and you need to know right away that YOUR issues come before your employers. You need to eat right, take your breaks, get your rest, and be pretty stress-free, in order to last a long time. When I say stress--the stress of the job never bothered me much, it's the politics and drama of the workplace that got me down, so I avoid those kinds of things as much as possible. I exercise religiously, eat non-processed food, stay out of the sun, and wear baby sunblock all the time. And, as posted above, get as much school as you can while you are doing well--you want to be able to get your pick of jobs. Always choose a job for your lowest level of wellness, not your highest. That's my path, choose the parts that suit you :)

Another thing to remember is that this more than likely is not about you. This is about covering themselves. Now, when upper management says, "What did you do about this fall?", they can say, "We had a meeting, gave the responsible nurse education, blah blah blah," and their behinds are covered. It doesn't necessarily mean anything about you, it's a paperwork deal.

Zoo vet Edit: or training search and rescue dogs

I can put the seat down OK, and I wash my hands before I use the bathroom anyway. I'd rather be in charge of my own safety than depend on someone else. You know 99 out of a hundred guys will be great...but then there's that one...

Things that made me crusty: I used to spend 75 percent of my time with patients and 25 percent charting. Now I spend 75 percent of my time on the computer and 25 percent of my time with patients. We used to keep patients in the hospital until they were well. They went home and they stayed there. Now, I feel that "revolving door" is exactly the right phrase. They go in and out, in and out, poor things. An addendum to that is that we did not let patients leave until they showed evidence of waste excretion. Now I am in a rehab facility, and I can't tell you how many patients we have gotten that have a note saying, "No BM in the last 8 days," or "unable to void." Also, the somewhat new corporate habit of telling nurses to go home if the census is low. I can't think of one other group of college-educated professionals who get treated like day laborers. (Not that I think that day laborers should be treated like day laborers, but that's a whole other gripe session). Do they call in extra people if the census and acuity level is high? No, they do not. I feel that if you endure the extra-horrid days, you should also get to enjoy the easy days.

It's a weird system. I had a hard time getting a powerchair. I explained that I needed it to work. "Oh no," they said, "You are only supposed to use it at home." I don't need it at home (mostly), but I work in a hospital, and you know everything is a hundred miles away. I told them, "But if I only use it at home, I'll have to quit work. I need it for work." "Well," they said, "...just don't tell that to anybody. Say you need it at home."

If God ever gave me a gift, it is getting the plugs out of trachs. It's an unusual gift, I admit. Anyway, my first week in the hospital on the cardiopulmonary floor, a guy came in with a really difficult plug. I start working on the guy, and apparently some of the things I did were new to folks, as a whole crowd starting gathering around me. There must have been ten or twelve people around me. After a few minutes, this young resident kind of shoves me aside and is all like, "Stand aside, missy, I'm going to save the day!" A little old guy behind me, that I had barely noticed, roars at him, "WHAT THE **** DO YOU MEAN BY INTERRUPTING ONE OF MY NURSES! DON'T YOU EVER TOUCH ONE OF MY ******* NURSES AGAIN! THEY KNOW WHAT THEY ARE DOING AND YOU SURE AS **** DON'T, YOU *** *** ***... etc." and chased the poor guy out of the room and down the hall, while the patient and I are both cringing back against the bed, looking at each other like paralyzed rabbits. All I could think was, "I'm sure glad I'm one of his nurses, whoever that was!" It turns out the pulmonary doctor on that floor had a reputation as a man-eating terror. He was always nice to me, but he had a real rep for looking out for "his people," staff as well as patients. And by looking out for them, I mean completely shredding any one who had the audacity to interfere with his floor.

I kept emergency food in my locker all the time, mostly not for me, but for my CNAs, who often got mandated to work a double shift and had no way to get food. If I had 2 or more people working doubles, we ordered pizza :) I always made sure everybody took their breaks and had stuff to eat. I used to be one of those people who worked through all their breaks, clocked out, and did my charting. Times have changed. I also figured out that the more tired you are, the slower you go. Taking your break and catching your breath probably doesn't take any more time than working at the speed of snail. You have to take care of yourself (and your staff), as your corporate masters are not going to.

They just banned wearing dresses or skirts at my facility. I was a little dismayed because I just read "The World According to Garp" and was thinking of wearing my old whites and cap all the time, like Garp's mom did :)

I went for a job interview with a group of interviewers from the new facility, and they asked what I thought would be best about my new job, and just joking around, I said, "No double shifts 4 times a week and weekends off--I have worked every weekend for the last 10 years!" The two doctors looked at each other and then at me and asked if I was kidding. The four nurses looked at each other and said, "You know, we do that here, too, right?" The doctors literally had no idea that the nurses in this facility worked like that, and they were horrified :)

Here's some reading you might like: Warning: Tight pants, skinny jeans and Spanx may be hazardous to your health - CBS News Why control pants can give you panic attacks... and the other hazards of too-tight clothes | Mail Online The dangers of squeezing into skinny jeans I remember, I think it was in the 80s, there was a flurry of news articles about girls with abdominal problems due to over drying their jeans so they would be skin tight.