Survey of Nursing Jobs:   A Nurse’s Story

A view of my own personal experience in nursing

What follows is the first in a series of expose's regarding the real scoop on several different types of nursing jobs. In this series, we will look at a ground level view of what life is like as a nurse in different settings. Not the employer generated hype that the recruiter’s spout verbatim from a cue card but the real-life adventures, anecdotes and aspirations of a nurse who has been in the trenches of some of the toughest nursing jobs from the E.R. to Hospice. Return often for updates and new installments bringing the ups, downs and sideways of nursing experience to light.

My first Nursing Job: Midnight shift on a lockdown unit in long term care of Alzheimer’s patients.

In august of 2002 I had just finished the first year of a two-year registered nurse program at a very good community college in Maryland.  During the summer semesters we had the option of taking courses to allow us to take the Licensed Practical Nurse exam, and as I need to be employed while I went to college I took the option. I had worked hard all the previous year, and after some time working minimum wage and worse jobs, I felt I owed it to myself to make a little more money and gain some invaluable experience that would give me an edge over my peers for the upcoming year.

            I suppose I should mention at this point that, as every good nursing student is well aware, nursing three and four were steps above the first academic year in difficulty. Nursing three included pediatrics and obstetrics/gynecology and nursing four was the capstone, care of the acutely ill adult with multiple stressors. These courses have high attrition rates and require considerable study time. My thoughts were that a midnight shift would allow ample study time (usually true) while being in an Alzheimer’s unit would not tax me too much physically (usually untrue). What I found out was that this particular specialty requires heart, patience, tolerance and stamina. The rewards are many but the frustrations can seem insurmountable.

The patients

            In this series I will always refer to those in need of nursing services as patients. I send my apologies to those instructors who are cringing at that but clients are for hookers and lawyers. The patient-provider relationship is a complex one and it does not need more monikers and tricky cutesy ways of naming those who need us. They are our patients and we are entrusted with their care. That being said, lets look at what kind of people become patients in an Alzheimer’s ward.

            One thing that should be realized is that the people with Alzheimer’s who come to a lockdown unit are difficult to cope with, otherwise why put them in a lockdown unit. Your D.O.N. might tell you it is strictly a safety measure, and that may be true for about 10 percent of the patients you will meet there. Most Alzheimer’s patients, however are trying at best and downright abusive and dangerous at worst.

A case study:     Manny G. (not his real name)

                        Manny was once a doctor, and from all accounts he was one of those rare human beings who has found a career that perfectly matches their personality. Stories of his practice abounded with tales of how he “took one look at me and knew what was wrong” he joked often had a sharp and keen wit and loved being a healer. He was tall, over 6 feet; yet lean and had a soft round face that when he smiled, made everything seem all right. When I first encountered many his wife told me stories and then I met others in our community who knew him and corroborated his wife’s tales of his kindness and generosity. Therefore it came as quite a surprise when Manny swung and tried to punch me the first time.  No one had warned me about his possible outbursts. It was late at night and in an instant he was mad, swinging and I had to get help from the charge nurse on another floor to calm him down and redirect him.

From this we can learn a couple of things. 1. Not every place you will work will give you proper preparation for the job. Training varies greatly in the nursing fields. One must be prepared for anything. 2. Alzheimer’s patients’ behavior can turn quickly. One moment they can seem completely at ease and the next can develop into an explosion of behavioral outbursts. Another thing implied in this case study will show if you were paying attention. I said I took the midnight shift. This shows that behaviors can show up at anytime. During that shift I often found myself very busy with several people up all night and doing things from wandering to getting violent.  I did get some studying done, yet when nursing four came around I found that I could not continue to give what the job required.

The Alzheimer’s unit it emotionally draining, especially if you, like me, fear losing your mind and memories far more than death. The time it takes to build the trust necessary to give meds alone can be a month or two. Everyday you go to work knowing your patients are not going to get better, and in fact will decline no matter how good your care plan is. That is the nature of Alzheimer’s disease. Couple that with all the frailties of human nature in the caregivers and next of kin, and it can make for a frustrating day. I have had to deal with everything from displaced anger, from children who feel guilty about leaving their parent to the care of strangers and are frustrated with their own inabilities to care for their loved one to downright subterfuge when a caregiver has a loved one in the beginning stages of the disease and cannot bring themselves to tell their parent that they are leaving them to us permanently. In that particular case, everyone told the old woman in our care that she was there for rehabilitation to get her to the point where she could care for herself again. It was at that moment that I was introduced to the idea of a “therapeutic lie”.

So what’s the rub here? Well, Alzheimer’s disease treatment can be very rewarding if you are the right kind of person. It can be a nightmare if the facility you are in is not in line with your style of nursing practice. Either way, we need people dedicated to the care of those who can longer care for themselves. I’m glad I did it. I’m also glad I left it, even though the reason I left was to both increase my income and decrease my hours so that I could devote the necessary time to studying. That brings us to the subject of my next installment, agency nursing. Yes, you can make a lot of money, but it is not for the timid. Look for the whole story next time here on A Nurses’ Story.

Robert L. White is currently a school nurse for inner city underprivileged children, owns two companies and writes copiously on many subject from religion to science