Bravely exposing the truth, or, just a plain rat.

Since I've switched to working the PM instead of AM shift, I've now been scheduled almost every work day with my "bestie" at work. We never had much in common but she was fun to hang out with...until we started working together ALL THE TIME. And being in such close proximity with her, I realized what a bad employee she was, and when it came down to it, a bad friend. Spending half the shift texting on her phone, talking about her latest sexual exploits while we were both pouring meds, leaving pills behind with residents rather than watch them take them (an important safety measure when you're working with the elderly), and generally not taking anything very seriously.

This friend has been going through a lot of personal drama lately, and distancing herself from it by flinging headlong into a new relationship. Soon, she was leaving early nearly every shift to go be with that guy. She knew it irritated me, and she started lying about the reasons for leaving early: when she left it would be, "I want to get home so I can spend some time on the phone with my son," and then the next day it would be, "guess what I tried in bed with so-n-so last night." I let her know the dishonesty bothered me, and that I felt taken advantage of when she cut out early all the time without doing her share of the work. She knows what that's like after all, she used to complain about another of our coworkers doing it to her all the time. We came to a sort of truce that I would try not to get bent out of shape with her leaving early so much if she would agree to be the one to stay most of the time when school started for me and I needed to cut out and go sleep or study.

Then I noticed that she was making some pretty serious med errors. Not giving pills that were supposed to be given. Continually skipping the full narcotics sign out process. Leaving pills in residents' rooms as a rule, rather than an exception. Signing out treatments without regard to whether she'd done them or not. At this point my irritation gave way to concern for the residents. I had covered for her once, when I knew she had omitted an anxiety pill from a resident's night time pour. I felt sick about it afterward, and it still bothers me. Part of my job is to check through the records and audit where mistakes are happening. If I'm going to be taken seriously, and seen as fair, I need to do that process without regard to whose mistake I'm looking at. I need to be unbiased.

Then one night, she gave a resident double the dose of a narcotic he takes to help him sleep. I understood why she made the error; the dosage of the pill had changed, and she hadn't been paying close enough attention to catch that change; a week ago giving two of those pills (of a lower dose) would have been correct. She just wasn't paying attention anymore. That particular resident is younger, has problems but still has a sharp mind. He asked her why there was an extra pill that night, and she blew him off. Said to go ahead and take them, and she'd research it and come back later. She never came back. I don't know if she realized she'd made a mistake and didn't want to deal with it or just forgot; she was in a big hurry to get out the door that night, and left about 2 1/2 hours before the end of shift.

The resident came to me and explained what happened. I looked at the records and the pills that were left in the packages and knew right away what she'd done. At that point there was no question in my mind. I had to call our supervisor. I had to step forward and put the mistake out in the open. I confirmed the resident's suspicions that he'd been given the wrong dose, and let him know I was going to call my supervisor for advice. He said he had the supervisor's phone number in his cell, so we could just call together, right then, and that's what we did. We explained to my boss what had happened together. I think it helped re-establish some trust with the resident that not all of us med techs are flippant, irresponsible jackasses.

My frenemy was put on suspension for a week, then fired. At one point the managers were talking about the possibility of letting her stay on as a caregiver, even though they didn't want her to handle medications anymore. I don't know if they gave her that option in the end or not. The resident is fine.

My coworkers are treating me differently now. One of them, one I really like, has expressed in so many words that he thinks I should have covered for her, and is treating me coldly now when he used to be very friendly. Some are labeling me as the backstabbing bitch. Most aren't saying anything to me about the whole thing, but I'm sure they're talking about it amongst themselves. A couple have let me know, in their quiet way, that they agree with my actions.

Update on first two weeks of nursing school

The first two weeks have been a little exhausting, but I think without the stress of everything that has been going on at my JOB lately I wouldn't be so overwhelmed. As it is though, managing both, I'm tired all of the time and in the last couple days have been pounded with a cold that stripped me of any remaining energy I had.

First of all, a word of advice for anyone reading this who is about to start nursing school: Do the first week's reading before school starts. Really. Even if you mostly learn by lecture, and have always done things differently in the past, just take my word for it. You'll be grateful you did.

I however, didn't, am at the end of week 2 and still not caught up. Thankfully I have only one day of class during the coming week and should be able to get my act together during that time.

I have had my first two clinical days now. It was in a long term care facility, and my assigned person to take care of was a very light load. She didn't need much assistance and I understood the health problems she had very well. If anything I think she was over-diagnosed, perhaps for funding reasons to make her able to stay there. They chart to highest level of care at the facility I was assigned to, which makes sense if you are trying to staff and run a place like that. I was struck by how meager the activity offerings are at such a place, which is privately owned but takes a lot of medicare people and is considered a medical facility, comparing it with my work which is mostly private pay and non-medical.

Last night, after my first two days of clinical, I had strange dreams about alien creatures that crawl up your anus and eat your rectum. Also, after having a morning phone call and then falling back asleep, dreamed of going through closets and closets full of someone's decades old hoarded clothing with my sister.

We've had two tests/quizzes so far. The first was about 60 questions, and you had to have 100% to pass it. It was basic math...fractions, decimals, rounding, etc. I caught one mistake on my second go through but it was 100% by the time I turned it in. Without knowing the actual figures, just listening to what my classmates are saying, about 1/3 will have to retake it, and the faculty planned for that. It's all too easy to miss one if your nervous. The second quiz was also on math, but dealt with conversions specifically related to medication. The main thing I didn't know for that was the old system of grains and drams. I studied up, was completely confident before and during the test, but somehow only got an 8/10. I wonder what I did wrong, but as one classmate put it, "it was probably something stupid and not worth our limited time to go back and track down the teacher about it."

Our exam next week is also in the pharmacology/math/medical data class. Between now (Friday afternoon) and the test (Tuesday morning) I'm going to focus mostly on catching up on reading/studying for that class, and some on prepping my research for my next clinical client. Oh, and the whole getting better from this miserable cold thing, I need to spend some time on that too. I'm also scheduled to work Saturday, Sunday, Monday.

Next post, immediately to follow, will be about everything that has been going down at my job.

One scary thing...

At the end of our all day skills day, our teachers sat the whole group down for a "serious talk" about the policies of the program. Most of it seemed pretty reasonable and manageable, like absence and tardy policies, etc. But many of us jumped when they outlined the policy on clinical practice plans.

They went into this long thing about how they are meant to help, not hurt. They will make us better nurses. Oh, I guess I should explain what it is first. If your clinical instructor notices that you are doing something wrong while out in a care setting, they will sit you down and you have to write up a plan together to work on making it better and eliminating the problem. That all sounds great. Maybe a little threatening just in that it's a criticism, but not a HUGE deal. And they say most of us will get one at some point, and probably more than one. Okay. I can cope with that. But then they say, oh, and by the way, every time you get one your grade drops by half a grade. So, say, if I have an A-, but then they notice that I forgot to wash my hands once in a situation where I should have, then B+. Ouch.

Makes me a little more nervous about going into the clinical arena with the instructor.

I've noticed in myself that in the first few days of school, I've been feeling kind of insecure, kind of shy. A little overwhelmed by everyone seeming to know my name and I haven't quite picked up theirs yet. A little self conscious when I ask a question that feels a little out of my league. Happy but suspicious that there's some negative connotation behind it when one of the other students teases me that I'm their class president (elections have not been held, and yeah, I've thought about it, but...).

Deep breaths. No biggy. This is going to be stretching my definition of who I am, but in good ways.

First few days of RN program

Monday: Arrive at 8am, sit through 6 1/2 hours of mostly lecture. Ask lots of questions and feel little timid about asking them because I don't know my teachers and classmates yet, not really. Feel completely awed by the first two professors I meet. Go to work immediately after school until 10:30pm, leave about an hour before shift end with my med tech partner's agreement, and crash HARD.

Tuesday: Arrive at 9am having slept like a brick the night before. Everyone is sitting in the same seats as yesterday. There are about 20 chapters of reading I was supposed to have done just for the first week, out of 16 or so different books, and feeling pretty overwhelmed by the quantity of information coming our way and being behind on the reading, but yet also thankful that I'm able to follow everything the teacher is saying so far, and that my most recent job has given me a lot of valuable experience that will help me in this first semester. Almost start crying during the portion of a lecture on therapeutic communication because I've just had a somewhat traumatic experience (for both me and the resident) two nights ago at work that is still lingering in my mind). Even more awed by the teachers today than the ones from yesterday. Especially one of them. I contemplate the fact that I never really admired my science professors as much as I do these nurses I've just barely met. Knowledgeable, wise, and so very intelligent, both academically and emotionally/socially.

Get to go home early that afternoon, around 1:30. Need to tune my brain out for a bit, so put on some TV and end up watching it longer than intended just because it feels so good to let go of that brain overload feeling for a few hours.

Get myself back on track, do a review of some math that's going to be on a test tomorrow (already!) to make sure I remember how roman numerals work and can do all types of fraction math with speed, briefly consider watching the videos about basic bedside care that I'm supposed to watch for tomorrow's skills day, but decide sleep is more important. Then have a fitful night's sleep.

Wednesday: Arrive on campus at 7:30am to the skills lab for an all day basic care activity nicknamed "CNA in a day". Realize that although I have been working in an RCFE (residential care facility for the elderly) for the last 8 months, I don't have a lot of the skills that are considered basic in a long term care facility, like giving a bed bath, sitting a bed bound patient on a commode, taking blood pressures the old fashioned way, brushing a patient's teeth for them or shaving their face, etc.

Tomorrow, Thursday, I'll be going to my first clinical site for orientation with my clinical instructor. My clinical instructor just got hired two days ago, and I'm a little wary of that fact. She will be shadowing another more experienced instructor while teaching us. She seems nice enough so far though.

Should I know already?

I have 2 weeks to go until nursing school starts, and I have to say that lately I've been feeling self conscious when people ask me what *kind* of nurse I want to be, and I really don't have an answer.

My plan has just been to get a wide variety of experiences during the clinical rotations that are a part of my school program, and at graduation time, go with my gut, or alternatively, where the jobs are. I don't feel like I know enough yet to be able to say, "OH, well, I'm going to be a pediatric nurse, definitely."

I currently work with seniors, and I like them, and they me, but I don't know that that's where I want to specialize long term. I could see myself moving around a lot within the nursing field to keep learning and growing. Or working on a unit that sees a really wide variety of patients. Or, hey, maybe I'll find myself just completely enchanted with something I have no experience with yet.

I have a friend who is a surgical nurse, and she loves it. A friend of that friend, also a surgical nurse, told me that she liked it because the patients are mostly asleep! Oh, and it pays well. But you have to be very, very good at getting along with doctors.

I am pretty sure that I do not want to work in a prison, or the state mental hospital. I want to be able to feel safe with my patients, for the post part.

I was reminded of my indecision again when one of the school staff was talking about helping us write our personal statements. And I was thinking, gosh, I bet they want you to say what area of nursing you are most interested in there, too.

In a scholarship application I recently turned in, I'll admit I catered to what I thought the scholarship provider would want me to say. It was a conglomerate that owns several senior care centers in the community. I expressed in my essay answers that I enjoyed working with seniors, and hoped to continue that. That's true, in a sense, but I don't know that I want that to be my entire job.

So, for now, the jury's out. One of the things that appealed to me when I was first starting to look into nursing as a career was that once you were "in the club" with that RN, you had A LOT of options, and you could move around, too, you weren't stuck where you started. Am I just rationalizing my indecision?

Betrayed by the financial aid office!

I found out today at a pre-school year test-taking skills seminar that I could have put in an application for a whole bunch of school based scholarships that I was aware of, but had been told by the financial aid office I was ineligible for due to already having a degree. I feel so betrayed. I would be eligible up the wahoo based on financial need as well as past educational performance. DARN. Next year I'll know better.

Note to self and other future healthcare workers

When I am a patient, and I am lying on my back with nothing on but a gown, two people staring at my vag, and one of them is a young man-doctor with a scalpel in his hand, the last thing I want to hear is, "Whoah, that's weird!" I finally had a much procrastinated boil lancing done in my pubic area this afternoon. It turned out that I couldn't bring myself to say anything to my regular physician (a 70 year old man) about it, so I opted to go to my local med stop, because, well, it felt more anonymous? I don't know. I've had the issue for two years and it's recently gotten worse; plus it looked kind of yuck and with me contemplating taking a new lover (not something I usually post about here!) I decided I need to get it taken care of. The "oh weird" they were exclaiming about was that I had a lipoma (fatty tumor) inside said boil, and that might have been what caused the initial irritation. At various other points during the procedure there were comments like "Oh, my fiance gets boils all the time, especially when she travels." And, "That's too scattered, that's more something for a general surgeon." Oh, and my favorite, "I can't wait to see the new men in black movie!" Again, not something I want to hear right at that moment.

The financial reality of returning to school

A couple of updates: I have my phlebotomy license now (but I'm not using it at the moment). My nursing school orientation is coming up in a couple of weeks. I finally, finally, finally have health insurance again...okay, so the card hasn't arrived in the mail yet, but I'm covered as of a week ago.

Nursing school is getting closer and I am getting more nervous about money. I have been working hard on shrinking my debt. I had about 6,000 in debt at its highest point in the last year. All on 0% apr credit cards, thank goodness, but it was still weighing on my mind. It's hard to get back on track when you only make $11 an hour, and medical bills come up, and taxes have to be paid, and the car needs new tires. I'm down to about 2,000 and if I keep being very careful that will all be paid off by August. But there really isn't any extra to set aside *for* school.

I think part of my worry is all of the unknowns. Will my low income fee waiver come through again (I need to do the FAFSA to find out)? Will I be able to keep working at least 4 days a week to keep my health insurance at least partly covered by work? My dad agreed to loan me some money (LOAN, with interest), but how exactly is that going to work, and will it be awkward and difficult? What will I do if/when unplanned for expenses come up during school? How much can I realistically work while I'm in the program without running myself into the ground? There needs to be time for laundry and paying bills and doing dishes and cooking, not to mention a small amount of just "down" time to keep my sanity.

Even though I've had these concerns weighing on my mind I haven't done a lot to remedy them since I got the hospital scholarship. I need to be applying for more scholarships, and go ahead and fill out that fafsa, even if I'm worried the answer might be no. I also need to stop freaking out about it, because that doesn't help anything. I will know more after my orientation meeting in a couple of weeks and then I can just continue to approach things rationally and one at a time. Deep breaths!

Phlebotomy license on its way

My state phlebotomy license should be here any day now. I got a call from the state public health office yesterday. They said my application was complete and everything was done correctly EXCEPT that my teacher didn't sign her title (CPT1) after her name on my clinical hours documentation. Jeez.

They're coming to take you away, hee hee, ha ha, ho ho

A resident who has been on hospice for a while now passed away last night. His wife, who has dementia, but gets around alright physically, was moved to the "memory care" facility across town this afternoon. This morning, she told her caregiver, "Did you know that a man in that bed there died last night?" referring to her husband's hospital bed.

It was explained to her what happened. They have been preparing to move her to the other facility for a while now, and were just waiting for her husband to pass before making the change. Our director said that in these situations, they don't tell the resident that they are leaving and going to another place for good. They just say "let's go for a drive." And they drive around a while, and just sort of end up at that place, and walk around a little bit. They say, "Look at this nice restaurant!" and point out the dining room. Then they eventually leave their loved one there to adjust for a few days.

My director said that they find in these situations it is kinder, when the surviving spouse asks where their loved one is, to say that he's on a trip and he'll be back soon. They don't remember from one day to the next. So if you explain that their spouse died, they will begin the grieving process anew. And the next time they ask (5 hours or a day later), it will be the same thing once more.

Part of me sees the wisdom in this. Maybe it is easier for the resident, easier for the family. The resident doesn't get all stressed and anxious about the move, it just sort of happens. And who would want their loved one to find out day after day for the "first time" that their spouse has died. I get it. But part of me also rails against it.

Somewhere within them, under the layers of confusion, they have to feel deceived. Maybe not all the time, but dementia comes in waves. And in those moments of clarity, if it were me, I would be pissed.

No more cell phones at work!

We had our monthly employee meeting today at work, and one of the most talked about announcements was that from now on, if you are carrying your phone with you during work, you will be written up, and if you are written up three times, you will be suspended for three days without pay. Managers are allowed. And night time med techs are allowed to keep their phones but only for work purposes (taking a call from our boss or calling 911, etc).

I am pleased as punch by this. I usually leave my phone in my car or in my locker while at work anyway, in fact, it came up just a few days ago when my boss sent me a text about 45 minutes into my shift asking how training a new employee was going. I didn't get the text until much later that night.

Yesterday, the girl I don't like much, K, ignored a call for help from one of the caregivers and kept playing on her phone. L, a coworker I like, was in the med room with her and couldn't step away herself (she was busy pouring meds), but saw that K just sat there at the desk and kept playing on her phone. She does that a lot.

One of the LVN's I've seen reach her phone just behind the resident's peripheral vision while in their room to text someone. She's almost 50! She should know better.

It's just not professional. We get 50 minutes of break during the day. That's the time to take care of personal communications. Or discretely, in the restroom or laundry room or something, away from residents' view.

Most of my coworkers didn't share my opinion, however. Sucks for them!

Good news, scholarship!

I got a $1000 scholarship from the hospital I've been volunteering at. I applied for it about a month ago; I had to write a few essays, get two letters of recommendation, and fill out some forms. And they only took applications from current student volunteers.

To receive the scholarship, I had to give a short speech at an awards luncheon attended by all of the other volunteers as well as many of the hospital administration, including the CEO.

This was roughly the speech I gave:

******
I have been considering transitioning to a career in the health professions for a while now. Nursing, specifically, has been a profession that I repeatedly revisited in my dreams about the future. About two years ago, I began pursuing this idea more seriously.
Although a stable source of income, and projected future demand in the job market were on my mind, my interest in nursing goes beyond these things. I really think that my background in biology, fascination with the workings of the human body, and natural ability to help people feel at ease telling me anything will go far in this field and I can make a positive difference.
Almost two years ago now, I moved back to my home town of XX, where I know that there is a very strong RN program at XX. I took the remaining prerequisites for nursing school and earned a 4.0 GPA while tutoring other students in English and Sciences to support myself, and volunteering my Saturdays here, to gain more experience in the healthcare setting. Last summer I submitted my application to the RN program, and just a few weeks ago found out that I got in, with the first cut.
To make a start in the medical field and to support myself up to and during nursing school, I recently began a position in the wellness center of an assisted living facility. I work as a med tech, pouring and passing medications, giving treatments, and responding to any emergencies. Between my experiences there and here at the hospital I can tell that nursing is going to be a good fit for me.
When I begin nursing school this August, I will have to reduce my work hours to accommodate my class schedule. There will be $2000 dollars worth of books to buy during my first semester, and as a second career student, I am not eligible for many sources of financial aid. I very much appreciate this organization’s contribution to my education. In a couple of short years, hopefully I will be an RN, working here at XX Hospital, and will see you all again.
*****

The CEO stopped me on my way back to my table and said it was a really nice speech. Yay!

Phlebotomy licensing

I finally sent off portion 2 of my phlebotomy licensing paperwork today. Been procrastinating a long time on that, partly because now that I got into nursing school, I doubt I will need the license, partly because of starting the new job as a med tech and just feeling really busy.

I took the licensing exam in December (4 1/2 months ago now)... was a little confused about what the next step was, and whether or not I had to pay more to NCCT (national center for competency testing) to get my national certification. Turns out I didn't. I paid I think $100 to take the initial test, and that served as my national licensing fee. Then for the state application, which I just sent off, it cost another 100. Plus I had to make copies of various certificates, order some official transcripts, and include two more passport photos (the national cert took 1). Hoops and more hoops to jump through but I think I dotted all my i's and crossed all my t's.

So, the plan is to keep that license up as a "just in case" fall back. Just in case my current job doesn't work out (I just had a positive 3 month work review), just in case nursing school has problems, just in case at some point I need to work as a phlebotomist for whatever reason. And it will probably be a good resume boost when I'm applying for nursing jobs in a couple of years.

Achoo!!!

So...about 5 weeks ago, I got a chest congestion/cough thing that had been going around through my work (both staff and residents). Then, just as that was clearing up (and it took about 3 weeks), I got another cold that started with a sore throat, then went into mostly head congestion, which evolved directly into a sinus infection. Then I finally got myself to the doctor for some antibiotics.

I had one of those ultra-vigilant, if I see a speck of green in your mucous we're calling your allergist for antibiotics kind of moms. Bad for antibiotic resistance, very...but I don't think until this point I had ever actually experienced a full blown sinus infection. Oh man, I was miserable. It felt like my upper row of teeth on the left side was being pushed gradually out of their sockets, my cheeks hurt, my ear hurt. All of that on top of the feverish, low energy, nausea from snot dripping down your throat kind of feeling that goes with your average cold. I was not a happy camper.

I've taken only 3 days off of work during this 5 weeks of yuck. I don't get any sick pay yet, plus we're short staffed, so it's difficult to take the time away. The worst of the sinus infection his during my two days off, then I took yesterday and today, and I'm planning to go back tomorrow, for what will be a 2 day week. Whew.

I'm exposed to everything that goes around at work. I'm exposed to everything that goes around my niece's preschool through her. But I'd like to think my immune system is decent; I eat fairly well, exercise, get a good amount of sleep. I need to wash my hands more, I guess, and be ULTRA careful about not touching my face EVER at work.

We don't have those hand sanitation stations around the building like they do at hospitals. I should probably carry hand sanitizer along with me (in addition to gloves) to use in between residents, and then wash my hands for reals on top of that every time I come in the wellness center. And I don't know what can help discourage me from touching my face...maybe if I put on some lotion, so my skin doesn't feel dry, and keep some tissues with me too, in case my nose or eyes are bothering me.

Gotta get these germs under control!

A little bit sad today.

Switching over from "independent" living to "assisted" living, I knew I was going to be exposed to death more often, but today is the first time it happened since I started the new job.

I had yesterday and today off, but I went in today in the afternoon for a work meeting. Two people had died since my last work day and another had a major cardiac event and was in the hospital.

The woman who died, I think I am at peace with. She was in her upper nineties, her health had been failing for a while, she knew it was coming soon. Some of the caregivers at my table during the meeting were talking about the process, how the tissue in her extremities had started turning blue and dying, and how she was scared to be by herself. I had a hard time listening to that, but I guess it is stuff I need to know. The signs I need to be aware of.

The man who died, he was the one who really got to me. A tall, lanky guy, fairly independent still, who all of a sudden went downhill about a week ago. I saw him every day, multiple times per day, but he was never asking for anything for himself, always just looking after his wife. "My sweetheart needs her anxiety meds." "My lady is in pain." He was very selfless. It is sad to see his wife left behind so sad and alone. Her family is with her now but they won't be forever.

The man who is in the hospital with heart problems, my coworker thinks will be back again. I was surprised to hear he'd had an emergency. He's pretty feisty.

I got a little teary eyed finding all this out right off the bat. I got some ice water and had some time to sit outside by myself before the meeting started.

I've never really believed that people "go to a better place" when they die. I think some of the comfort that comes with that thought would be nice right now.

I got in to the RN program!

I got a letter in the mail last Saturday. I'm in!

I start August 20th of this year.

The new job as a med tech at the assisted living place is going well. I've got a good reputation there, among the residents as well as the staff. It has been an adjustment, being on my feet all the time, but I'm doing ok with that as well.

I will write more soon. My cat recently used my keyboard as a scratching post and tore off several keys, so the typing is a struggle at the moment, but I do have a lot of new stuff to share.

Kind of disgusted.

I went to my first monthly all staff meeting at the new job. They announced the "employee of the year" (last year's) and I had a feeling I knew who it was going to be, I've heard other people talking about it, but I was hoping not.

See, there's this one girl on staff who has been there a few years now, longer than my current supervisor, and she, although she is a favorite of the managers because she'll always cover a shift or fill in where needed, is a total thorn in my side. And I'm not alone. Even our supervisor has talked about her being rude to the public, and how that's not a good thing. She's the leader of this little click with two other girls, and they always sit around and make fun of the other staff, and many of the residents. She is especially mean when it comes to new people on staff. The last new person before me she (and her click) make fun of for being *too sweet*. Because she works hard and has a good attitude.

One employee told me that she requested never to be put on shift with K because K disrespects her. I personally believe she was messing with my walkie-talkie for the first week and a half of my work there so that I would never hear incoming calls...and when I complained about it to my supervisor, she then made fun of me for complaining at the first opportunity.

Also, because she has been there so long, she does most things by memory rather than looking at charts/etc. And there are two instances in the last week where a med error was made and I know she is to blame. In one, she was on shift on a Saturday, and when a resident who recently returned from the hospital asked about her B12 inhalations and why she wasn't getting one that week, K told her that she's not on that anymore and walked out before any further discussion was possible. This was related to me by the resident. I checked her chart and she *is* still supposed to get the B12 inhalation and she did miss it that Saturday.

The second was more dangerous. Some residents get their blood pressure checked early in the morning, and if it is below a certain value, one of their medications is supposed to be withheld so their pressure doesn't go *too* low. This resident's systolic was already below 100. The LVN on staff who has been mentoring me said I should look through the recent treatment records and see if I saw any trends in blood pressure worth looking into, and when I did I came across that record. The instructions there on the treatment page say to withhold metroprolol if the systolic is below 100. I asked the LVN to look in the MARS (medication assistance/administration record) and according to that documentation, the med hadn't been pulled. She and I went to the resident's room together and checked the woman's BP several times. It was quite low (top number around 85-90), and we both agreed that it didn't look like the med had been pulled as ordered.

Together, we told our supervisor about it. She is young, unused to managing people, and close with the employee who messed up. And there have been 4 documented and reported med errors in the last year, and if there's another one it will come with a hefty fine and perhaps further consequences to the facility. She said, "Oh. Hmm. Well I will check with K and ask if she pulled the metroprolol this morning."

I get it that sometimes if it is busy, it is possible that she followed protocol and just didn't document it. But we both saw that the resident's pressure was too low, even lower than it was earlier that morning pre-medicated.

Since I'm on a rant here about employee behavior, there's another instance that is bothering me. There is a resident who is having an episode of back pain right now and has had trouble getting back and forth to the bathroom. Apparently a few days ago during noc shift, she pressed her pager for help, and it took a while for someone to come. The resident reports that the staff was "mean" to her, saying things like, "I don't know what you expect me to do if you can't tell me what you need!", "You should be in the hospital!", and "You need a bedside commode, there are only two of us on the floor." I wrote down exactly what she said, and told her I was sorry that she had to experience that along with her current episode of back pain. Then, as soon as a chance, to related what she said to my supervisor. She thought through who would have been there that night, and said, "No, I can't see so-and-so ever saying something like that. That resident's perception is a little off right now. I will talk to so-and-so (staff member) and see what happened from her side."

I appreciate that she doesn't jump to conclusions when there is a chance her staff has done wrong, I really do. But when she's getting multiple complaints about one particular employee, she really needs to take action on it, even if that employee is her favorite person that she can always lean on.

What really chaps my hide, so to speak, is that two of the reasons that our supervisor wrote that she should be employee of the year are her record of "mentoring new employees" and "doing things accurately".

Ugh.

Middle Fingers and Generous Spirits

It has been a couple weeks since my first day as a med-tech / caregiver, but there were two stories I wanted to share from that day.

First, I was in the wellness center learning what my role and responsibilities would be as a med-tech. I was there with C, an LVN, and K, another med tech. In walks a frail senior lady. "How can we help you?" someone asks. She looks at us and flips her middle finger.

It turns out that she has a chronic crack on the tip of her middle digit that she regularly comes to the wellness center for to get ointment :-) She either has no idea of the significance of pointing that finger skyward, or is doing it ironically.

Later that day, I was in another residents' room. She had been dizzy and needed help back to her room, and I was alone with her helping her put on some new depends. She's going on about how comfortable this particular brand is, how it doesn't sag or bunch...and then she looks at me and asks, "is this the kind you use? You can have some if you want!" Completely serious face. I thanked her for her generosity but said no, I don't use that kind.

:)

Workout at Work

In my efforts to lose weight and get healthy, I have been wearing a pedometer for the last few months, every day. When I was working a combination of the receptionist job and teaching, I would get from 3-6,000 steps per day, generally. Since I started the med-tech / caregiver position, I get more like 10-12,000. The caregiver work (currently 1 day per week of my job) is more physical. Kneeling to put on ted hose and shoes, serving in the dining room, etc. The med-tech is also very physical but a few less steps in the day.

So far, so good. I've been more aware of my right knee, which has been tender for the last several months since I fell on it in late November. I was worried that my plantar fascitis problems would come back again with the increased activity, but so far, so good. I have been wearing my orthotics every day, as prescribed.

I sweat A LOT at work. Part of it is the physical activity, and being a larger gal. The other factor is that inside the building it is at least 75F at all times, and in the resident's personal rooms it can be much, much warmer, depending on their preference. I have been using residents' kleenex or toilet paper to mop my face when needed, but I should probably start carrying a hankie or something in my pocket. Sometimes when I take off my gloves, sweat splashes out of them and my fingers are pruned. I mentioned the sweat issue to another caregiver I was training with last week and she said she sweat a lot at the beginning too.

At one point, I was riding up in the elevator after serving a meal to the residents, and the woman I was working with that day asked me what was wrong. "Nothing, really!" I kept saying. I then understood that she thought the droplets falling down my cheeks were tears. Just sweat, I promise.

Accepted a new job. RELIEF.

Two days ago I accepted a new job (within the same company) and put in my 2 weeks notice at my current position. My current supervisor at the receptionist job asked if I would be willing to fill in sometimes if needed and I said I'd be glad to.

My new gig will be full time, 40 hours per week, with benefits. I will be spending part of that time as a personal care assistant, and part of it as a medication technician. They are starting me at $11 per hour. I will have benefits after 90 days. Huge. Sigh. Of Relief. If I have to cut down to half time during nursing school (likely) I should be able to at least get back on a COBRA continuation again. Another plus? They provide the uniforms. One less ongoing expense to worry about.

I had two interviews for the job. The first one felt like a hole in one. Totally rocked it. Had no doubt I was going to get an offer. The second was a little rockier but I felt like the decision had already been made on their part by that point. I also talked to the other place I was considering, the paid CNA training program, that day, and there was promise there, but I decided to go with the med tech job for two main reasons:

(1) the paid CNA training gig would have only been $8.70 an hour (vs $11)
(2) if I decide it would be useful to have my CNA license after all, I will be able to apply for that after my first semester of nursing school, which, assuming I get in, is only 11 months away.
(3) I like that I will be spending at least part of my time as a medication technician, which requires some state-mandated training (another thing to add to the ol' resume).

During the interview, the manager said that if I ended up getting into nursing school they would be able to work with me on hours as well. I don't know what kind of course schedule I will have during the first semester of nursing school. I know it won't be a good idea to work full time, even if I am tempted to. Have to wait and see.

I am just a little bit concerned about my pre-employment physical, which is happening next Friday afternoon. I already had one for the receptionist position but because I will be on my feet more and stuff they are having me do another one. I also need to get my TB records together again, and all that jazz. It may be about time to renew my first aid training again as well. They will pay for all that if necessary.

I know that this job will be more physically taxing than my current one, but it should be GREAT preparation for my nursing career. And probably being on my feet all day will help me slim down.

So, again, whew.

to CNA or not to CNA that is the question

So...I have finished my phlebotomy training, but it will be a while before I get my certification all ironed out with the state, and it could even longer before I'm able to nail down a job in that field, if at all.

The local college did not need me to teach any classes this term. They go to the faculty first, the graduate students next and *then* the part time pool by seniority, and between the low course offerings during winter and being the newest of the newbies, no luck for me.

I've still got my retirement home receptionist job, but that is only 19 hours per week, and at $10.50 an hour and no benefits, you do the math. No es bueno. Not getting by. So...

At the end of last week I saw that a caregiving facility I applied to almost a year ago for their in house CNA training program was starting a new training round at the end of January. I managed to get an application in the day after the announcement went out, and I put a lot of energy into my resume, references and cover letter, so I'm hoping I have a good chance there.

Secondly, I also put in an application to be a "medication technician" at a care facility across town from, but owned by the same company that I currently work for. The CEO at my current job found out pretty much immediately, asked me about it, and I explained the situation. It turns out they won't hire a non-CNA for meds passing, not really, but several days later he told me that I should apply to be a caregiver at yet another facility owned by the company. I put that application in tonight. It would be full time, so I would get benefits after 90 days. However, they do not have an in-house CNA program; I would not graduate to certified nursing assistant over time or have the job portability and pay raise that comes with it.

My inclination is that doing the CNA program at the un-related-to-my-current-job place may be the best opportunity long-term. I would have to find out pay rates, etc to be more confident in that statement, but even if I just stayed there 6 months, got my license, and then moved over to the hospital where they make twice as much, it would be totally worth it.

However, if I tell my current employer that I need more hours, they say, alright, here's an opportunity, and then I don't take it, that's a little awkward. Or what if it becomes a timing issue...what if my current employer says, okay, sure, let's start training you in the new job, and then *days* later I get word that I got into the on the job CNA training program?

I should call the on-the-job-CNA place tomorrow and ask if they have had a chance to review my application, and make sure there isn't any contract that mandates 1 year of FT work following training (as some places do), or anything like that. How can I carefully bring that one up, huh?

On-the-job-paid-CNA-training-thingy:
$8.70 per hour (lame)
3 months-ish to get CNA license
benefits, probably after 90 days
my friend who used to work there said the new company cut down on overtime possibilities
the last time I applied, when I met the teacher, I had a positive impression of her
After establishing my CNA license I could move somewhere that pays way more

Caregiver position with my current company
Pay unknown (maybe more than the other since I already have a history with the company?)
Benefits, but after 90 days
they are not set up to train someone who has little experience in caregiving, to my knowledge
No idea what hours they'd want me to work


When it comes down to it, I really don't need the CNA training if I'm going to be an RN in a couple of years anyway, but it might help me stay better afloat financially while in school...maybe....

Doubts...

I've just finished watching the final Harry Potter (weepy) and looking through all of my friends on facebook (lonely) and I'm in a sort of _where is my life headed_ sort of place right now.

Did I make the right decision to move back home and start in an entirely different direction?

I look at old friends' profiles. One that I used to live with is living in Australia now, as a yoga instructor and writer. One that I used to work in a research lab with changed courses several years before I did and is now a nurse practitioner. Another that I went to high school and college with is now a physician's assistant and has a young son. Friends that are professors, and work at nonprofits, and manage or own companies, and have families of their own and children.

And I can't help but compare. I'm 31, still struggling to "find" myself, no partner or prospects, considering applying for a job that would pay lower wages than I've made since I was 19. What if all this that I've been going through is for nothing. What if I am not a good nurse or don't enjoy my work at the end of it all. What if.

I need to get myself out of this downward though spiral.

I've done a remarkable job of holding it all together, juggling obligations, and continuing to move forwards. During the time I have been home, even if I haven't made great strides forward in my career, at least I have managed to form a strong bond with my niece, who I love dearly and with my whole heart. Everyone goes through lost periods, even if not all at once, and at different rates of recovery. It feels like a long time coming, but I *am* moving forward. Soon I am going to hear back from the nursing program and I am most likely going to get in. Even if not right now, there are times when I *do* think that nursing will be an excellent fit. People trust me, and I am a caring and compassionate individual. And I am smart. I should be able to do this. I can do this. A year from now, everything will be completely different. I won't continue in this in-between state forever.