9.30.2008

New Scrubs


Today I spent a shift at the skilled nursing facility I referenced in a previous post. I got up early to make it in time for Morning Report, after sleeping for only four hours. I have a bad habit of doing this, for some reason my habitual reaction to "something important" happening the next day is to stay out all night with my friends. I was relatively good, I got home before 2AM ;p . I bought new scrubs for the occasion, the only other pair I own are the white scrubs I wore to the pinning ceremony. I ended up going to three different uniform shops before I found a pair that complimented my eyes just so.

I didn't feel all that great about how my interview went last week, on reflection I noticed that the director of nursing did all the talking. In other interviews, the interviewer took the opportunity to grill me on my knowledge and auger for the appropriate interview buzzwords. Then again, after several interviews where the interviewer did all the talking and several interviews where there was a more equal give-and-take between me and the interviewer, I haven't gotten -any- jobs, so who's to say?

Anyway, I absolutely love this place. I didn't think I would be so enthusiastic about entering into practice at a skilled nursing facility, but this place would be fine, just fine.

I wish there was a camera crew recording my day there from several angles, it was like TV show The Office but in a nursing home. I'll try to reproduce as much of the hilarity here as I can.

When I arrived, I greeted the director of nursing and followed her around for a little bit, exchanging pleasantries and getting some info about the census to prepare for Report. We were in the documentation room next to the nurse's station. In the distance, we started hearing people yell the director's name. A chorus of all of the staff members started to bubble up from the halls and into the small room we were occupying. Her expression shifted suddenly when the words "The State is here!" could be heard.

She quickly beckoned me to follow her into the break room, where she told me to sit with a nurse there who was going over documentation. This nurse is an LPN, but due to her lengthy experience in long-term care, she acts as Charge Nurse. I ended up following her for most of the day. While the inspectors from the State were closing in on the nurse's station, we busily set out un-propping all the doors and scouring the halls and charts for things the facility could get slapped with a "Deficiency" for. This facility has a great record, the only deficiency they received in the past year was for a single I/O entry being left blank. Not bad considering all of the things that -can- go wrong.

When I finally arrived at Report, I got to meet the Executive Director, the Director of Recreational Therapy, the Director of Physical Therapy, the Director of Admissions and the Lead CNA. The LPN I was following conducted the report, which was interesting to listen to. It basically contained everything they needed to know about 38ish people in a concise way. Everyone was friendly and seemed to tolerate my presence well.

The side conversations and flurry of activity that was going on around me was priceless, I felt like I was in a mockumentary the whole time. The CNAs were friendly and fun to be around, the Lead CNA was a fiery woman with a thick Scottish accent and a sharp wit. She joked that the inspectors kept trying to interview her but gave up when they couldn't understand what she was saying.

I observed one of the State inspectors conducting a staff interview with the LPN I was following. The sense that I was in a mockumentary intensified a thousandfold. He asked a series of questions about five patients, the same questions for each. Are they catheterized? Are they receiving a nutritional supplement? Do they have bedrails up? Are they able to get out of bed independently? Have they fallen or fractured a bone in the past 30 days? Each of the four inspectors typed with a single-finger hunt-and-peck method and wielded their laptops clumsily, as if they were unfamiliar objects. I later found that the laptops were a new addition to their survey routine. I corrected the inspector's spelling of HEEL, he spelled it HEAL. I just couldn't let it slide. I spent some time chatting with the inspector about QIS surveys and Medicaid while the LPN retrieved charts on the rare occasions she couldn't produce the information from memory.

After I had a chance to enjoy several hours of witty repartee between the LPNs and the Minimum Data Set Nurse, the LPN I was following excused herself to take care of a personal matter. She suggested I pop in to the office of the Assistant (Associate?) Director, after warning me that once I did he might "talk my ear off".

"Sweet," I reasoned, "I didn't feel so great about how my interview went last week, so maybe getting some face-time with an administrator will help my chances". I was hesitant at first because he seemed busy, but I was assured he always seemed busy, and that it would be fine to drop by his office.

They weren't kidding that he liked to talk, but I saw this as a good thing. Something I first noticed while I was in Japan was that administrative types are often the people who have the most control over what they do with their time, which allows them to invest a good couple hours here or there to talk, give a tour, or play a board game, as the case may be.

In this case, we talked. I could see why the other nurses "warned" me that he was a talker, but I viewed it positively. The art of conversation is a dying one, and I got the sense that maybe he enjoyed having an intelligent conversation partner as much as I did. He's a very interesting guy, he has a graduate degree in public health and our conversation covered a wide range of topics; health care, insurance, the role of nursing in the healthcare delivery system, electronic charting, the economy (of health care and otherwise), long-term care, family caregivers, we even discussed our personal histories and ambitions. The conversation had a slightly paternalistic ring to it, which I didn't mind. He was, after all, in a leadership role, and I was one of two non-patient males besides him in the building. I engaged him in conversation until -he- had to excuse himself to get back to work, and when I emerged from his office I noticed that most of the rest of the shift had gone by.

I stuck around to hear the CNAs report off to the next shift, catching the tail end of the Scottish Lead CNA rolling through her patient load in a brisk, efficient lilt. Afterward the director of nursing introduced me to another RN who was "previewing" the facility (oh no, competition!), and told me to call back later to let them know if this job was something I would be interested in. I immediately assured her that, yes, I was definately interested. She told me to call back Friday "when the State is gone", and we can discuss "what the next step is". I kinda felt like she was trying to get rid of me.

On the walk back to the car, the Scottish CNA told me that the behavior I observed from the director of nursing wasn't necessarily a bad sign, just how she was, and that spending the time chatting with the administrator was the right thing to do. She wished me luck, bummed me a cigarette (I know, I'm trying to quit, really), and I headed home.

As I left I was suprised by how badly I wanted to work there. Not just because it pays almost $30 an hour; I enjoyed the pacing of the place, the relatively small number of coworkers I had to interact with compared to the beehive of hospital life, the offbeat humor and warm acceptance of those coworkers, the opportunity to develop longer-lasting therapeutic relationships with the patients, the eventual option of traveling within the company, it's a good match on a lot of different levels. The acuity isn't very high, and I still want to get into emergency someday, but this looks like a good place to enter into practice, even if they still chart everything by hand (for now).

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