I don’t really know what the point of my post is but I am feeling quite upset by some things in my working life that I need to get it off my chest. It’s a long one so you have been warned.
I have been a nurse for 30 years.
The first half of my career was working in cancer and palliative care and the second was in nurse education, mainly supporting student nurses on clinical placement. Got offered voluntary early release from the university so took it – but I wasn’t ready (or financially able) to stop working completely so I took a job at a lovely care home just round the corner from me.
A friend’s mum was a resident not too long ago and she rated it highly plus it meant a short walk to work and no commute, so I was really looking forward to doing clinical care again. But OMG – what an eye opener it has been.
I just was not prepared for how bad staffing is in the care home sector, the lack of resources and the level of waste has appalled me.
I enjoy the job itself but it has really made me think about my own future and that I need to make an advance directive now as I don’t want to end up living in a care home and just existing.
Staffing levels are dire. On a good shift, we will have a ratio of one staff member to five residents. There is one nurse and one nursing assistant on a shift and the rest of the staff are carers. Out of 32 residents, 27 need two staff members for personal care, continence care and moving/transferring/mobilising. Only 2 residents can feed themselves/take a drink independently. There is at least one agency nurse or carer per shift – often more. This means they don’t know the residents well and don’t understand their needs and preferences. There are also a high percentage of male carers who do agency and most of the female residents have specified in their care plans for only females to provide personal care. Given that women live longer than men, the residents are about 70% female to male. This means that often the male agency carers have very little to do whilst the female staff are run ragged. It also means that residents have to wait longer for care because the female staff are tied up meeting other residents’ needs. Sometimes we have no option but to ask the male carers to attend to a female resident’s care if the resident has dementia and is unable to say no to the male carer input, which feels really wrong to me. We are in the middle of a huge debate about trans women getting access to female spaces yet the issues of males having ‘access’ to some of our most vulnerable female members of society is not really considered.
The level of waste is truly shocking. An example is that last week we received a 3 month supply of high fluoride toothpaste – around 120 tubes. Since the toothpaste is prescribed, it is labelled with an individual resident’s name, meaning it cannot be given to another resident and if it is not used, it will be returned to the pharmacy and destroyed. I would estimate that about 90% of the residents who are prescribed this toothpaste cannot have their teeth brushed because they don’t consent to it (evidenced through spitting at you, hitting you and spitting it out) they choke when you try to do it or they are simply too weak to have it done to them/ can’t open their mouth etc.
The amount of medicines the residents are on is also eye opening. We have 95 year olds who are very frail and have less than 6 months to live still getting anti-cholesterol medications, folic acid and iron supplements and the like. A lot of the time, and I mean a lot, the medications are not tolerated by the residents (tablets too big even when halved and if effervescent is available, too big a volume to drink). Those with dementia just spit the tablets out. Last week we returned about 200 high protein drinks to the pharmacy for destruction as they hadn’t been used and were out of date.
But you cannot get a GP to stop prescribing as they don’t want to look like they are not treating the resident well. No one seems brave enough to say ….”look, this person is not going to benefit from cholesterol lowering drugs so lets just stop them”. In my palliative care practice, someone at the end of life had their medications stopped and were only on end of life meds to palliate symptoms.
I’m not talking about meds that help such as pain killers – but those that are just not going to add anything to the quality of the resident’s life. So we have all this money being spent on meds, high energy drinks, toothpaste etc but we can’t buy enough pressure relieving mattresses or employ more staff, both of which would do more to help provide better care.
We have one lady at the moment (aged 98) who is very frail and cognitively impaired. She has contractures, her skin is like tissue paper and is constantly tearing, she is doubly incontinent, unable to swallow much and is in a lot of pain.
But the GP won’t prescribe her morphine as he feels it is too strong for her frail state – if she had terminal cancer, no-one would think twice. She screams out all night, asking to be ‘put to sleep’, upsetting other residents and keeping them awake. We cannot sedate her – she is prescribed a medication for agitation, but she refuses to swallow it. In her lucid moments, she describes how her life is a living hell, she feels trapped in a decaying body and just wants to die.
I truly think we have lost our way when it comes to care of the elderly. People aren’t allowed to just get old and die anymore – its like we want to keep them living but for what? I’m not talking about treating reversible things which cause distress like urine infections – but really, what is the point in giving vitamin D tablets or iron supplements to someone who will likely die in a few weeks.
I don’t know what to do with regards to my employment – I want to remain and do the best I can for the residents but I am getting more depressed and frustrated at work. I spend around two hours of a 12 hour shift writing about care rather than actually providing the care. This is how long it takes to update the residents daily care plans – so I will be writing things like “Betty enjoys sitting in the garden and reminiscing about her time as a teacher” – but I can’t actually find the time to sit and talk with her and we can’t spare anyone to take her to the garden.
So AIBU to leave my job because I am finding it upsetting?
YABU – you have taken a role with vulnerable people and you need to stay and help provide care for them.
YANBU – you need to protect your own mental health and leave the work to those who can cope better with it.