I have less than 5 hours to sleep before my next 12-hour post at the nursing home.

For the first time in my life, I actually have something interesting enough to write notes about. On my way to the coffee shop tonight, I grabbed an ancient, small, untouched moleskin notebook. I bought it intending it to use it for notes and things during nursing school, but nothing I heard or saw there really inspired me to write any of it down (except for my blogging, that is).

Now that I'm responsible for so many people, ideas come to me when I'm off the clock, so now I have a notebook to write them all down. I just write entries on the lineless paper about the residents, identified by either room number or initials. Remember to get an Albumin on this resident. Follow up with dietician about this other patient I just discovered a pressure ulcer on. Councel this other patient about their diet choices and changes in diabetes medication.

After I leave all sorts of interventions and consults blossom in my mind, so now I'm writing them down.

Along with those, I'm jotting down things to talk to the Director of Nursing about.

While walking through one of the halls of my unit, I overheard one of the agency LPNs raising her voice to a resident. I leaned against the wall outside the door and sighed as I listened to this nurse yell at one of my residents.

She was crying because she thought the resident called her ugly. She told him that she had been in and out of this room 15 times already this shift, and if he could remember anything for more than 5 minutes he'd realize that. Now, this is a somewhat demanding patient, but he's on the long-term care side so there's plenty of extra time to help people out.

I took her aside as she left the room and asked her what was up. She tearfully explained to me that she hadn't had much sleep and couldn't handle the abuse from the residents. I told her that I didn't care if he called her a fat bitch, these residents have dementia and memory loss. They can give us all the shit they want. I immediately wanted to send her home. It was towards the end of the shift, I could easily have finished her meds and treatments on my own. I consulted with the other RN on duty, and she suggested we give her a moment to cool down and finish her work, while we took over the patient she hollered at.

I see the wisdom in giving someone an opprotunity to cool out, but there was really no excuse for what I overheard. She gave tearful excuses about being overworked and not having enough sleep, but I had no sympathy. So you're saying you're practicing while impaired? That's not much better.

Even worse, I found that she administered two 5/500mg vicodin to a resident who already had 4000mg of tylenol that day. Now, the first 1000mg was given at 00:30, so it was borderline, but this guy was in liver failure, and this LPN administered what was technically his FIFTH GRAM of acetaminophen for the day, and the max dosage is four grams because of the potential of liver damage. For a resident like this I'd be wary of even getting up to that fourth. I started filling out the med error report and paged the doctor (who never called back, as usual), but the RN shadowing me said that the first dose was close to midnight so it's not a big deal.

Things are going to run a lot differently when I'm off orientation, that's for damn sure.

The emergency calls from the independant living apartments are a constant source of amusement for me. This is what happened when I answered a call this same night, 10 minutes after I should have clocked out.

"This is PM at the health center, what's going on?"

"I can't poop! I've been sitting here for hours and nothing's coming out."

"Well, unfortuantely I can't bring you a laxative or anything like that, we can only respond to emergencies."

"What about an enema? You don't have to give it to me, just leave it with me."

"I can't do that either, sir, our supplies are for our patients, and you aren't one of our patients."

"Oh, I see..." He started to trail off, obviously frustrated.

"Lemme ask you this," my customer-service-mode was kicking in: "how long has it been since your last bowel movement?"

"Oh, about a day or so, I guess."

"Well sir, I wouldn't be worried about that until three days have gone by. Going three days between bowel movements is perfectly normal. Call Mrs. X at the visiting nurses station if you haven't gone after three days, ok?

"Ok, thanks, sorry to bother you."

Now, I was half-hoping there was something serious going on, like chest pain or a fall-with-fracture, but when I hung up that phone I felt a warm relief knowing that there really was no emergency, that everyone was really OK, and they didn't really need me at all.

I had plenty of other people to worry about.

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