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This site contains the highly fictionalized ramblings of a raconteur looking for a place in the medical world. The vignettes presented are cobbled together from various and sundry places.  Any resemblance to actual people, places, or events is purely coincidental.

And, I like to photograph things in lieu of words some days.

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Wednesday
Oct162013

The Home

Tap...tap...tap...  Is this thing on?

Or maybe I should be rapping myself on the head a few times, to see if that thing is on.  Why oh why don't I write more.

Maybe 'cause I'm finally working as an RN.  In a nursing home.  Five eight-hour shifts a week.  Something like four on, one off, three on, rinse and repeat.

This is not where I intend to end up.  But it is where I am and I'm making the best of it.  These here lemons are making the best damn lemonade I can.

-

Yes, I'm a nurse.  Nope, I'm not working in a hospital.  Yes I'm working in a nursing home.  Nope, that's not what I want to do with my career.  Yet often on a new journey, the beginning can have the rockiest of starts.

I'm on the skilled floor of a long-term care facility.  I have hospice patients, g-tubes, traches, the occasional IV drip, and often lots of medications to pass within an insanely short eight hour shift.

I've been there something like eight weeks and already I've been allowed to train two people.  One I graduated with, one from a similar nursing program in the area.  I could infer that the fact I'm training people might mean they feel like I know what I'm doing.  But on each shift there is the sheer moment of panic when I realize I'm a nurse and I'm expected to know a lot about what I'm doing.

I'm not sure that's always the case.

My fellow coworkers are helpful for the most part.  When somebody gets overloaded we work it out.  That's not the hard part though.  Getting to know the patients takes time.  This is their house.  This is where they live.  Their baseline is in front of me every day (hopefully) and it's up to me to learn their ways of living, taking medicine, interacting with others, etc.

It's so very different from a hospital.

-

Basically I've been nursing a population of about 90 people, 30 at a time.  Yes, you read that right.  On any given shift I can have somewhere near 30 patients.  When you know your patients, it's not as rough as it sounds.  But when you don't know them, every cough, sneeze, sound, smell, and question about their status can send you into a tail-spin, trying to navigate for relevant information.

In fact today, I added another 30 people to that number.  So that makes 120.  I know most of the 90 folks well by now, and I'm officially working on two floors of the facility, both skilled and semi-skilled.  It's all about time management, safety, and prioritization.  Eight hours goes by quick.  Two med passes, the occasional admit, sometimes a transfer to the ER, and lots of charting takes up the full shift and then some.

If there is anything positive about what I'm doing as a nurse at the moment, it's the immense amount of manual skills I'm doing on a daily basis.  Foley's?  No problem.  Straight-cath?  Sure.  G-tube feedings, flushing, medication administration, I got that covered.  Tricky trache changes?  Yup.  Suctioning whatever body part needs suctioned?  Mmm hmm.

Timing treatments, keeping pain meds on schedule, making sure people are fed, vitals assessed, blood sugars monitored, and insulins given?  I'm getting my internal organizational tools in order and getting it done.  I'm bad at starting IV's but there isn't much chance to start them.  I'm also pretty fumbly with big-time dressing changes, but again, that's not often in my domain so I can't get the practice in.

In short, I'm doing "nursing" with the volume turned up.  And while it may be a little too loud at the moment, I'm making all sorts of motions to change my work situation.

I see a tiny spark of light at the end of this tunnel.  Soon it'll get closer.  In the interim, I've got 30 people on my watch.

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