A 36 Hour Day


Early in my nursing career, I was green, like most new nurses are. There is so much to keep straight, keep track of – I found it somewhat difficult to hone my bedside manner while, at the same time, keeping track of the medication schedules of 15 different patients – – wound dressing changes, meal times, special diet needs, physical therapy schedules and on and on. On top of that, as a newly graduated Registered Nurse starting her career in the midst of one of the worst nursing shortages this country has experienced (turns out? that nursing shortage never did come to an end . . it still exists today) – – by virtue of the RN licensure, the hospital administration makes you the shift supervisor – in charge of all the other licensed practical nurses (LPNs) and nursing assistants (NAs) – – so you’re automatically in charge of the, their duties and responsibilities – – dealing with the NA who has to go home early because her boyfriend is threatening to leave the children alone, and the LPN who is pregnant and puking in the bathroom, meanwhile her patients need their medications….you get the picture.

Anyways – one of these evenings, I had a patient who was having some real difficulty. She was an elderly Alzheimer’s patient – – in that stage of Alzheimer’s where she just isn’t aware of her own safety limitations anymore and really needed constant supervision — so much more than our floor could really provide, because the staff was constantly short. Her daughter was great – – being a veteran nurse herself, she fully understood what happens when 3 of the floors NAs and 2 of it’s LPNs don’t show up for work and 2 of them went home early. The very unfortunate reality of it is, as nurses – – we do the absolute best we can with the resources we have available to us.

This daughter sat with her mother every single evening – – it was always the evenings (they call it Sundowners Syndrome) where she had the most difficulty. This particular shift, I was running around like a chicken with my head cut off. Short staffed, as usual — and remember, I’m brand new. Maybe… a month? out of nursing school – – and completely in charge of this floor (say nothing about the responsibility of the hospital administration and their wisdom of putting a green nurse in charge of anything..but that’s a whole other post. Desperation and budgets do scary things to the ethics and accountability of hospital administration. Sad. But true.).

Fast forward to almost the very end of my shift. I’m doling out medications to 30 patients with one hand.. changing bedpans, sheets and fluffing pillows with another hand – – while my left eye is on recent lab reports and blood work and my left ear listening to a doctor shout orders to me (while writing out those orders with my right foot probably) . . my right eye is on the call lights down the hall and the NA on the cell phone in the nurses station while my right ear is listening to a patient’s husband tell me why his wife deserves a better room with a view..and he wants it now… actually, was demanding it now – – – my Alzheimer’s patient falls. On the floor. Cracks her head open.

Her daughter comes to get me and I drop everything I’m doing to tend to her and get her sent down to XRay. Right after I get her sent off to XRay – – the next shift comes in. I report off to the next shifts RN… finish up my paperwork and start my way out of the hospital thinking hard about my Alzheimer’s patient and her daughter.

Her daughter was not accusatory. She was very matter of fact, pleasant, nice and understanding.

Me? I felt like absolute shit. I don’t think I slept for a full 2 days after that…well at least not well. I kept going over that shift and asking myself what I could have done different…how could it have been avoided? It was all my fault – – I knew it and spent many painful hours blaming myself for all the woes in the world. I kept seeing this patient’s face in my head – – vulnerable, dependent – – completely counting on me and my staff to make sure she’s safe, even with her limitations. And I was too busy. By the end of my self pity party – – I’m sure I was even blaming myself for the unrest in the Middle East.

A month into my nursing career, I was ready to quit and go work at McDonald’s for the rest of my life.

I had two days off after that particular shift. I was thankful that the next time I had to go into work, it was a Saturday – – because I was really scared that I would end up being called into my Administrator’s office and fired for negligence. As it turns out, I was never even questioned about it by my boss – – and when I finally worked up the nerve to go talk to her about it and explain how I felt about working with such low staff resources – – she didn’t even know about the incident . . and ended up telling me that additional staff costs too much money and there aren’t enough nurses out there to satisfy the needs of any hospital floor in the country.

Wow. So much for that idealistic view of nursing. I learned relatively early that hospitals are run on a day to day basis – – whatever gets us through the next 24 hours without a lawsuit….we’ll do it. We’ll worry about tomorrow, tomorrow. Administration didn’t really ever seem to care, or have an ear, for what was actually going on out on the floors – – as long as budgets were met and no angry family members or patients threatening lawsuits (just watch how fast hospital administration can jump into action when they hear that a patient’s lawyer is on the floor visiting them!)

I’m sure I’m exaggerating. And, quite honestly, 15 years later I am wiser and my view isn’t quite so cynical and jaded — it is, however, realistic and pragmatic and you begin to realize, with experience, that you do the absolute best you can and that is all anyone could ever possibly ask of you. You understand the reality of nursing shortages versus patient needs and you compensate as much as possible, hope that you have a kick ass staff of nurses to work with – and learn to lean on one another for support and help. It all seems to work out — nurses and nurses assistants are a phenomenal bunch of people (most of them) – who can work together to meet the needs of a group of patients no matter what the atmosphere.

But, as a green, naive, inexperienced nurse on that shift the day my Alzheimer’s patient fell on the floor? I was scared, angry, bitter, resentful, shamed, worried and any other negative emotion that you can dig out of the Thesaurus.

That next Saturday? I came to work a bit early – in hopes of really getting myself organized and ready to meet this next shift head on… eye to eye . . face to face and make it through without crying or wimping out of the whole nursing idea.

The Alzheimer’s patient was back on my floor. She had only two stitches (geez, my memory remembers it much worse than that!) – – and the daughter met me in the hospital cafeteria when I was getting a cup of coffee before my shift. I saw her coming. I thought to myself “oh shit .. here she comes… she’s gonna ask my name, rank and serial number and turn me into the nursing board and I’m gonna loose my license before I even start my career!”

“Lisa”, she says, “I just wanted to thank you for the other night. For doing everything you could for my Mom. She sometimes thinks she can still walk without help . . and I turned my back for a moment to wash my hands and she was on the floor in a split second. I haven’t been able to sleep for two days…..”

We sat down and talked for the next 20 minutes about that day. I couldn’t believe she felt bad. She couldn’t believe the level of my own guilt. We were the two most misunderstood women in the hospital that day.

Before she left – she handed me a book. She said it’s a book that helped her a great deal when learning to deal with her mother’s diagnosis of Alzheimer’s disease. She had tried taking care of her Mom at home, first – – and I could never beat the level of guilt that she felt when she realized that she just couldn’t do it herself any longer – – that it had become unsafe for her Mom to be in her home. As a caregiver, she said – “I’m burnt out. but I didn’t really know how burnt out I was until Mom was admitted to the hospital. That gave me some free time at home and I didn’t even know what to do with myself or that free time – – so I spent that free time here, in the hospital taking care of Mom – – because I don’t know what to do anymore – – I can’t remember what life was like before Mom got sick”

The book she handed me is called “The 36 Hour Day“. I would recommend this book for anyone who takes care of an ill family member – – or if you ever have. It’s title eludes to how caregivers really need 36 hours in their day when dealing with a serious illness of a family member – – in particular illnesses that involve memory impairment like Alzheimer’s. In order to take care of yourself, and take care of your loved one – you really need 36 hours in a day..if not more.

Don’t’ ask me what made me post this this morning. I spent 15 years in nursing – – a career that I left almost exactly a year ago. I consider this a break from nursing – not a total departure. I will return someday.

I guess tonight it dawned on me that this will be the first Christmas in 15 years that I’m not spending with a live pager on my hip with the very likely possibility of having to be called away from my own family on Christmas day to go help someone else’s family….or fill in when the nursing staff is so short staffed they simply can’t cope.

The last 5 years – I spent working in home hospice. I wore a pager all the time… 24/7. I’d be afraid to go to sleep at night..worried that 30 minutes after falling asleep, my pager would go off and I’d have to get up, get dressed and drive for an hour to help a patient who was in intractable pain… or help a family member deal with the death of their loved one in the middle of the night. Usually, it was the nights that I talked myself into actually going to sleep..tell myself that the pager would be kind – – those were the night the pager would definitely go off.

I will actually be able to spend this Christmas with my family without the worry of being called away. The first time in 15 years.

Holidays were always the worst for these families – – worse than any other time of the year, if that is at all possible. Strangely enough…I’m kind of missing it…and feeling a sort of void this year. How bizarre.

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9 thoughts on “A 36 Hour Day”

  1. Not bizarre at all. It’s in your blood. I feel the same way about EMS and the police department. I miss it, even after being gone for four years and I entertain the idea of going back to the police thing, but it would be too much of a sacrifice on the kids. EMS, though..I submitted my application for our ambulance company last month. Now that the kids are a little bigger, I can do the volunteer thing as a medic. 🙂
    I think I might get that book for my own mother-she cares for ~her~ mother full time at home. Thanks!!

  2. Great post Lisa! I have so much respect for anyone in the medical field. I don’t know how yall keep everything straight. I think I might get that book for a coworker who is going through a rough time with every single member in her family with either cancer of heart issues.

  3. Laura & Yaya – that book would truly be the best gift you could give someone who is taking care of a loved one at home. it not only helps you with how to take care of yourself – – but gives a wealth of information on what you can do for your loved one who is suffering the disease.

    since I worked in home hospice — all of my patients were being taken care of in their homes. Caregivers ranged from dauthers to mothers, husbands, wives, sons, nephews, nieces, cousins or even the next door neighbor. As different as each of thse people were, individually, the one single common thread that bonded them together as a group (whether they knew it or not) is that not one of them took care of themselves.

    it’s a combination of things.

    Guilt is one. “If I take a shower, Mom might need me – so I’ll just put a baseball cap on and call it a day”

    Need is another. Just the time it takes to look after their loved one. medications, safety, food, bathing, doctors appointments.

    Emotional exhaustion is another. Ever deal 24 hours a day with someone who doesn’t have a memory anymore? It’s exhausting,to say the least. The patient’s own cycles of emotions run from frustration to joy to sorry to paranoia — and the caregiver is on teh receiving end of all of those emotions.

    it’s hard. I have a tremendous amount of respect for those family caregivers and the sacrifices they make — sacrifices that they don’t consider to be as sacrifice….it’s just love… it’s family.

  4. My own mom has been preparing for the day when I come get her, move her in with me, and take care of her until she dies. Don’t think I won’t be leaning on you and your expertise when that happens! She’s already showing signs of Alzheimer’s – forgetting more than she would – more than I’ve known her to forget.

    What a load you carry with you though, all of the patients you’ve cared for and some that you grew attached to – your level of personal responsibility is so huge it’s no wonder that you feel strange not to have it this year.

    Congratulations on your first un-interrupted Christmas with your fiance and children, you might even be able to replace the sound of a pager with the sound of “swoooooosh”!


  5. Pingback: Mom 2 Mom Connection » Blog Archive » Ode to the Christmas Nurse

  6. thank you for posting your experience. It has shed some light for me. As I am still a stressed out c.n.a.
    I work with alzheimers patients too. And I think I can benefit from the book you mentioned. Again, than you. *smiles* ~ Julie ~>:d<

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