Jay bee

I found the MRSA infection to be especially troubling. A doctor examining me in the ER (nonstop vomiting 24 h + from migraines) practiced handwashing diligently as evidenced by the raw red flesh of his hand - but apparently failed to wash above his wrists. He rested his wrist on my face while examining my pupils. The next day I developed raised red bumps where his wrist had been, and soon my face swelled up like a balloon. It happened so fast that the treating physician in my clinic couldn't tear the gloves from his hands fast enough to write the prescription for the antibiotic regime I would need to take to save my life. The scars left behind on my face are daily reminders of the speed and voracity through which an infection can burn through skin like a wildfire. I wash my hands and wrists with soap and water, rinsing well, and applying lotion.

Well stated. Especially the part about feeling like a human punching bag. Reward/benefit ratio is unrealistic but then nursing has been defined by women from the beginning. At least we are no longer required to wear dresses and heels! And yes, there were heels. And those f**king caps to keep on our heads to further define rank.

Been an LPN for decades. This has been a survival job. Raised kids and kept a house, but unable to progress due to health issues (shift work exacerbated migraines, caused other health issues). Earning a four year degree was easy in comparison to the hurdles of going from LPN to RN - never did cross those hurdles. Still an LPN, still getting treated like an overpaid CNA, still can't leave as pay is just high enough to be above minimum wages. Hurdles to pursuing RN included scheduling for clinicals vs need to work availability (bills keep coming), the insane prerequisite to redo A & P courses after less than a decade of completion of college level work and continued practice. Still keep training new RN's who either lack spatial intelligence or truly cannot disconnect from tech long enough to be plugged into real life. After decades as an LPN, even with a life science BA, earning $2/hr more than 20 years ago. Still finding myself needing to 'dumb down' to meet current job expectations. People who have worked with me, including RN's, are dumbfounded that I am still working the LPN license. I can't even begin to imagine a retirement - yet my cohorts are able to choose that luxury either by proximity to partner or long term planning. I am now forced to either find a way to reinvent myself and create a new career after age 60 as (finally) the kids are grown & on their own, I left my ex after giving him most of our assets - but I am free. Poor, with a new mortgage, but free. So, do I like being a nurse? Yes, I love being a nurse. I like helping people. I like being proficient at planning their care and being able to improv when the plans fall off track - and still reach goals. I like the knowing of the differences between flesh and bone and spirit. I have been privileged to be in the presence of many intimate and powerful moments that only a nurse would have access to witness. It is in that world I remain strong and capable and useful and valued. On the other hand, when I leave that world to try on new job descriptions in the corporate world, I become like roadkill. I have never been able to explain to their satisfaction why I continue to work as an LPN even though I have all this experience and education. There is surely something I am not revealing, something dark and onerous, perhaps I am just a waste of time. Plus I am now old and time has not been kind. Nursing is a great career - but only if you are an RN with a plan.

How do you "handle" someone who expresses her loneliness, losses, and frustration by acting out like a "witch"? You get to punch out and go home. As long as this is treated on a personal 1:1 engagement - it will never change. Feelings will be hurt, needs will remain unmet, and the dynamic will continue. What sets her off? What triggers these flames? As soon as you absorb the patient's tirades as a personal attack you cease to be therapeutic. She is as a tiger in your "zoo" and you are as the rotating tourists you rattle her cage just by virtue of "doing your job". Can you work as a team to discuss and possible create new approaches to create a more positive dynamic? I agree that it is not pleasant to deal with loud and angry people, but you know what? This will get worse for everyone if ignored. If nothing else, contact the patient's physician for solutions. Or engage the support of other departments, such as OT, activities, PT.

Look into their eyes. Tell the residents what you will be doing to them - elicit their cooperation. Never impose yourself on them if they refuse. You are still a stranger in their world. You are in their home. Protect their privacy. Close the door. Pull the drape. Don't yell. They may need more time than your time. Never rush. Anticipate moves. Needs. Ask for help if you are not sure. Sometimes our elders are as frail as butterflies. If they smell bad or appear unclean - it is not because they are old. It is because of the care they have not been given. Case by case basis. Wash your hands. Never touch your face. MRSA is common. Remember universal precautions. People will be who they are no matter what their age or infirmity. Respect that. And enjoy this experience.

You are the resource and the leader for the LPN's. You need to know procedures & protocols for your facility as well as the laws that govern your license. So get out of your own way and learn to be a nurse. Listen and observe. Get to know the people you work with as well as the residents. For the residents, this is their final home. Respect that. Respect them. Get to know the difference between a DNR and a Full Code. Are you comfortable with death and dying? Get to know the electronic charting, the paper charting, and how to speak with a doctor/NP on call. Get to know what the routine is for each and every floor and every nurse. That way you will know when a deviation occurs and be able to follow up before you are summoned or before a crisis occurs. Skin tears happen. Incident reports are common. Ignorance is common. A lot of the people who take care of the residents also have outside lives. Some have chaotic lives. Some have poverty and subsist on the leavings of the residents meals. Some feel entitled to possessions of the residents they are charged with. Get to know your people. Not the persona they shine on you, but the person they become when they don't know you are on the other side of the door. Walk into a resident's room after the caregiver has "completed" their care. Observe. What do you smell? What do you see? What does your gut tell you? Safety first. Does the resident have easy access to their call light? Has the bed been lowered after the NAR has left the room? Did the nurse pour meds into the dry mouth of a confused resident and then leave the room? Are the resident's hands clean or sticky? Is the TV or radio blaring? Turn it down or off. Talk one to one with the nurses and caregivers. Show respect. Be firm. You are not there for anyone to like you; that would be a benefit of the job. Don't indulge in gossip - you are there to set the example, whether or not you are aware of that dynamic. You are a role model. You are not their "friend". It is a privilege to be a nurse in long term care. You are often a confident. An angel. The only one who cares enough to give of your time and just listen. Or the only one with the power and ability to intervene and assess. Narcotic diversion is easy in nursing homes. I have worked with nurses who had a special juice pitcher on their cart for them. Alcohol included. I have worked in large facilities. The supervisor was well liked by all. The supervisor had a major addition to narcotics and whole cards of narcotics would disappear during a shift. Disappearing patches. Morphine injections that aren't giving the dying resident any relief. Because it has been diluted with water from the bathroom tap. After the nurse self medicated in the bathroom. Watch for this. The signs are subtle. Residents, for the most part, have little choice but to trust what the nurse puts in their mouths. Med errors are common. Neglect can be common. Follow protocols and learn who your people are. To what degree and what intervention is your call. Your assessment. Your choice. The emergencies are few and far between - it depends on your people and your facility. It is a slower pace. It may grow on you. Give it a chance. Trust yourself. You are a nurse.