A day in the life of a nurse in long term care

I arrived before the sun was up for work this morning only to discover that my "problem" patient from yesterday was up ALL night long and was STILL being a "problem" And she had pulled her catheter out.......

Nursing skill in action #1-Loaded her up with Xanax and said a silent prayer that she would finally fall asleep and wake up out of psychosis. Inserted a new Foley catheter and said another silent prayer when I got it in the right spot the first time I tried. Such a wonderful feeling to put that cath in the place you suspect and see yellow liquid come rushing through the tubing. Such accomplishment.

While on AM medication pass discovered first patient that had decided to open up their depends and play in feces. I was feeling generous today and instead of finding the CNA responsible for cleaning the mess, I cleaned her up.

Nursing skill in action #2-Cleaning up feces. I made it through my whole clinical experience in nursing school without cleaning up feces.......to make up for it, I have a job where I do it daily.

Still on morning med pass, discovered patient that I was 98% sure was expired. Yep, kicked the bucket, gone to heaven, out of this life......went to get my stethoscope to listen for heart sounds after shaking the patient and trying unsuccessfully to get her to respond. Reached down to listen for heart tones and her eyes flew open, she sat straight up, and took the biggest breath of air I have heard in a long time.

Nursing skill in action #3-Don't call the mortuary until you are POSITIVE the patient is in fact gone spiritually. Try the nursing magic touch first, you may just restart the life cycle.

Med pass continues, find second patient playing in feces. This time I am not feeling as generous and find the CNA to do the dirty work.

Nursing skill in action #4-delegate all skills you don't want to complete to appropriate staff.

The rest of the afternoon goes smoothly. Medication pass is completed and all patients are appropriately medicated and I begin to do my charting. First fight between female patients breaks out. I jump up and my role of nurse turns to security. I break the guilty parties up and luckily got there while it was still in the hair pulling phase. Parties were separated and I escaped without a hit or scratch.

Nursing skill in action #5-Sometimes you must act as a bouncer and be the peacemaker between fighting parties. The real skill is breaking up the fight WITHOUT becoming part of it and I mean breaking it up without getting hit yourself.

Fight number 2 breaks out. I am not involved this time just an observer.

The shift begins to wind down and I am thinking I am in the clear. Not yet though. Patient decides to begin acting COMPLETELY crazy. She is standing up out of her wheelchair and running down the hall. She is a HUGE fall risk and after running after her 5 times to catch her and sit her back down I move her over next to me at the desk. I give her a magazine hoping to distract her while I wait for the doctor to call me back. I turn around and she begins to beat me in the back with the magazine.

Nursing skill in action #6-NEVER turn your back on an agitated patient. Since it was the end of my day, I forgot this vital skill and paid the price. Unfortunately, so did the patient. See, she did this in front of the nurses station in front of about 6 other disoriented female patients that could see I am visibly pregnant. World War III broke out as they all swarmed in to attack and the forces were more than I could handle. Thankfully more staff was called in and the fight was disbanded without injuries.

The next nurse on duty arrived and I was more than ready and grateful to hand over the keys! I can only imagine how much fun he is having tonight. I was driving home reflecting on my day and I decided that instead of ordering xanax and medicating all the patients on the floor, the doctor should leave a PRN order of xanax for the nurses. Maybe that was my problem to begin with. I shouldn't have started my day giving xanax, I should have started my day TAKING xanax.

Bring on this baby, I am so ready after this nursing experiences.