If you are the one reader [this may even be an overestimate] that read my super eloquent tirade on working in surgical rehab facilities (i.e., skilled nursing facilities or SNFs), you may know that I loathe them and would not wish that fate on anyone I know. This goes for both being a worker and being a patient in the nightmare-as-a-place-of-healing.
Recently my job has had a lot of staff turnover [read: people quit all the time], which is not really a surprise. And now that I care for 14-15 people a night with half of the normal staff, I want to light my hair on fire and run screaming from the building. Indulge me when I say I am working as fast + efficiently as I possibly can while trying very hard to not make any errors, and I still leave feeling like an absolute failure of a human. I probably feel like that because on any given night 1-2 patients or their family members will in various combinations of words tell me that I am doing a crappy job and am a crappy human. Yes, a thick skin is important. Yes many of the patients are in various states of delirium/dementia and I shouldn't take it too personally. But they don't even have to tell me, I know I am becoming a crappy nurse and hate it.
I spend my days rushing around as quickly as possible with a grimace-almost-a-snarl. I'm not able to actually engage with patients and their families with any more than a curt pleasantry and a clipped answer to any question BECAUSE I CAN HEAR BETTY SCREAMING DOWN THE HALL or because a nursing aid is the room saying Joe just fell again and is bleeding from the head.
I realize now that the way most nurses get stuff done is by not doing it! Awesome. Of course the big stuff gets done - most of the medication pass, IVs, blood sugar checks and insulin administration, etc. But I've had patients tell me their [supposed-to-be] daily dressing changes haven't been done in days and I pull off the dressing and it smells like a sewer and looks like one too. Or they say they haven't been showered for 6 days. And they are incontinent. Or that they never got their breathing treatment that they need for you know, not gasping for air like a 75 year old with COPD.
Also, can I just recount this error that happened recently? Errors do happen, but this was a I-feel-ill-that-this-could-even-happen type of error. A patient admitted one evening and the admitting nurse used another person's medical record to transcribe that [wrong] patient's medications onto a paper MAR for the new patient.
Let me first enlighten you on the MAR. Since many of these SNFs are not a bastion of cutting edge technology, we use paper charts and a paper Medication Administration Record (MAR). You probably know this, but a MAR is the long list of physician orders that you use throughout your shift to know what medications or therapies a patient needs. It's almost unbelievable that paper MARs still exist since they depend on being able to read what the nurse with crappy handwriting wrote and because of the little known fact that COMPUTERS ARE A THING. And electronic MARs are widespread and reduce medication errors.
So anyways, the new patient received the WRONG MEDICATIONS FOR THREE WEEKS. Wow. I can't even wrap my head around that. She was receiving multiple strong blood pressure medications and the doctors couldn't figure out why her blood pressure was so low and kept trying to titrate her dose. The error was finally noticed when she discharged home and her regular doctor read her chart [including her medications] from our facility and called with a big ole WOW!.
Regardless of that incident, I feel like I've already outstayed my welcome. If I were to continue for another 20 years like a good lil employee that I know I'm not, I would probably need a partial lobotomy so that I could become OK with giving [what I believe for myself to be] sub-par nursing care. Yes, I've met good nurses. But in my experience a lot of nursing cares cannot be completed because of chronic poor staffing, of course at the detriment of the patients. I'll politely decline any continuing involvement in that.
So now I've jumped around to enough jobs to know many of the things I dislike and cannot tolerate. And after waiting around in the purgatory of unknowing, kicking rocks and hoping an answer would magically bloom in my mind, I thought to apply to this one hospital that is known to be really great, with a rehab unit. And it had one opening that had been on the website for a few weeks. And after one particularly bad string of shifts I threw my vulnerability [and caution] to the wind and just applied, thinking it was probably already closed and I'd get an automated "duh, it's closed" response. But I got an interview! And then a second one! And then I shadowed for half of a shift. And it was so amazing. Everyone seemed genuinely happy to be at work. It was a strange thing to witness. I almost wanted to touch their faces and ensure that they were people and not just robots. And everyone was helpful and supportive of each other. And the nurse I was with had time to actually listen to each of her patients for more than 1 minute. And it wasn't absolute chaos. It was almost unbelievable that a place like this existed all along.
It's kind of like dating crappy people over and over and you start to think it's just you (note: it partially is). But then one day you meet a person and they're just as weird and silly as you but they are also loving and supportive and it feels like you've found home. I know I'm fast forwarding a lot here, but that's what it feels like.
In summary, hooray for a new job where I can be more of the nurse I want to be! To all of you lovely nurses that are in a crappy job where you feel like a shadow of the nurse you wanted to be going into nursing school: GET OUT. One way or another, get out and apply to new jobs, they exist. And it can be better, if you let it.
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