Nursing home nurses can make you scared to live in there
Nursing home nurses can be Scary People Sometimes
There are some nurses working nursing homes who are caring and compassionate people, unfortunately they are usually few and far between. For the most part, many of them say and do things that are what I could only describe as ‘scary.’ For example; the DON of the nursing home decided a woman with dementia was a ‘disruption’ and needed to go out for a psychological evaluation because she kept removing her shirt in the hallway. This concept of going out for psych evaluations always made me cringe because if people have dementia, going out for a psychological evaluation usually meant the facility wanted them drugged. Why anyone with dementia would need a psych evaluation is beyond me. I had to make arrangements for this because the Administrator and DON were adamant about ‘sending her out.’ When the resident returned to us, the hospital where she had been sent for a psych evaluation called from their Social Services department and said this lady would remove her clothes when she perceived she needed to use the bathroom. Again, this observation may have been noticed if there were permanent assignments given to staff. When I relayed this observation to the Director of Nursing (DON) her comment was; “Why would she take off her shirt to go to the bathroom?” People with dementia, as mentioned previously, remember bits and pieces of how tasks they used to perform are carried out. A person with dementia will ‘remember’ something has to be removed to use the bathroom but cannot always recall what article of clothing is removed. Since the shirt was the only clothing she had easy access to, she probably felt, in her own mind that the shirt needed to come off. She was not able to verbalize any longer what she wanted or needed. The fact the DON made such a remark made me think she expected dementia residents to ‘understand and think normally’ in every situation. Extra staff for dementia residents works much better and is healthier for the resident than psychotropic medications.
This was a scary concept to me because each and every staff person has training in understanding dementia and nurses should have extra training in it simply by virtue of their nursing license. This is the sort of example that tells me many nurses do not take time to get to know residents either. These are not the kind of people whom I want to care for me when I am old and are probably only nurses for the paycheck alone, nothing more. Many nursing homes rely too heavily on mind altering drugs to control people’s behavior, especially dementia when it has been proven these drugs do nothing for dementia. All the drugs do is control a person for convenience of staff. Those drugs do nothing to improve a good quality of life for the resident using them. Whenever residents were ordered the powerful psychotropic drugs it was usually because a resident had dementia and was combative. Residents with dementia sometimes become combative and cannot help it when they strike out, usually due to confusion or being afraid of not knowing what is happening to them.
good observations go a long way
A couple of other incidents in the nursing home concerned me as well. One of them involved an elderly woman and her husband who, at the time had been residing in the facility for 10 years. At one of their care plan meetings the husband mentioned that every night after dinner, his wife had chest pains when she tried to lay down for bed. The nurse attending the meeting said she would request an order from the doctor for medicine for indigestion. A few nights later the woman was rushed to the ER and she died of a massive heart attack. From most of the literature about women and heart attacks, the symptoms can masquerade as heart burn. The second incident also involved an elderly woman who was overweight and sedentary. I came to work one morning to find out she had gone to the ER and subsequently died from complications of diabetes. This woman was not on insulin and nurses said they had no clue she was even a diabetic. These two incidents scared me because I began to wonder how these medical conditions could just slip past nurses and doctors. Is it because they were elderly and the medical doctors see no need for tests because of their ages, or is it due to nurses not spotting signs and symptoms. Both of these incidents might have been avoided if staff were given more permanent assignments. Perhaps staff, with a more permanent assignment, might have picked up on subtle changes in those women’s conditions, I do not know for sure, but both incidents are scary to say the least. Those incidents did little to exude confidence in a traditionally run nursing home. If families think their loved ones need another opinion and do not like answers given at care plan meetings, they need to inquire further and maybe even obtain another medical opinion. I do not care how old anyone is, everything possible should be done to ensure a person’s health is taken care of. The first woman should have been given an EKG to rule out heart disease and the second one should have been given a diabetes test due to the fact of being overweight and sedentary in her lifestyle. As mentioned before, most often the LPN’s and the RN’s hired in nursing homes are often sub-standard compared to those hired by hospitals.
the bottom line syndrome in nursing homes
This is usually due to nursing homes wanting to preserve their bottom lines. Private owners have less cash flow to work with, and corporations have to show a profit for stock holders. In either case, saving money and making a profit can translate to short changing the residents of the facility in many ways. If wages were increased, nursing homes would be able to attract a higher quality of worker which would translate into higher quality of care for those living there. Better care would also result in less abuse and less cutting of corners concerning goods and services. The really good nurses in nursing homes are few, they exist and when they are found they generally the ones who are expected to do a good share of the work, making them exhausted. Whenever a person from my department would answer a call light and a resident needed something, usually the nurse at the station would tell us it would get done as soon as an aid was available. This is ridiculous, at best. Nurses are trained to do the same tasks nursing assistants can do, and then some. This is a sign of lazy nursing when they think they are there to do mostly paperwork and nothing else, except dispense some medications once in a while. The facility where I worked had probably three really good nurses and the director of nursing was not one of them. This particular facility was only concerned about the bottom line and so was the administrator. This was a place where the term ‘team player’ only meant you were in the pocket of the administrator, I saw many good people who had been there for years, go out the door like smoke. The administrator never got it, the owner never got it, and probably still do not get it to this day. It is a sad thing when people are a commodity and the bottom line is valued way above customer service in nursing homes.
Sometimes I envied the nursing department as theirs was a cut and dried and black and white world, pretty much. Medical training does not have as many shades of gray as Social Work tends to have. If a resident did not fall blindly into place in attitudes and behaviors, once entering the nursing home, then it was a problem for Social Services. Nurses were best dealing with that ache Susan has, or the loose bowels Marvin is dealing with. Sometimes I envied their neat, tidy and medically ordered little world of mostly black and white problems. Problems that seemed to be easily solved with this pill or that shot, into the correct area of the body. It is a bit harder to heal a person’s mind and soul when this new, strange place does not resemble home or even look anything like a home should be.