Management

On Monday and Tuesday, I was on the third floor, shadowing Joe. Wednesday, Thursday, and Friday, I shadowed Jane. Jane works hard and constantly, interacts with the patients like they are human beings--she addresses them by name and jokes with them and is clearly concerned for them. She has been a great example and teacher, although even she and I had a conflict during dinner the first day I shadowed her--she asked me to feed a certain resident, and while I started to do so, I realized that the resident was picking up her own fork and attempting to get food on it, and simply didn't have the coordination to do so. She could guide the empty fork to her mouth without a problem, however. So I started spearing bites and leaving the fork on the side of the plate for her, and she did fine. She'd had 3-4 bites this way when Jane looked up, saw the fork wasn't in my hand, and said, "You have to help her, she can't feed herself." I said, "Yes, she can, she just needs a little help." So Jane got up, and began feeding the resident herself, hurriedly. I have taken very seriously the idea that my job is to help residents and patients achieve their highest level of independence--this is important for their physical health, because they need to move, and for their emotional health, because it makes the difference between helplessness and self-esteem. The NACs, even the fabulous ones like Jane, have such a large workload (10 residents to herself), that they tend to do everything as fast as possible, which tends to be to the detriment of residents' exercise of any sort of autonomy.

Later that day, I began pushing a resident in her wheelchair towards her room, since Jane wanted her to get there faster. Stella, the supervising LPN on Jane's side of the floor, saw me and said "Ms. Smith can push herself. And she needs to! She needs the exercise. It's the same way with feeding residents who can feed themselves." I was very glad to hear her say this.

Stella pays attention to what's going on on her floor, stops NACs in the dining room from talking to each other and has them talk with the residents, helps out NACs by doing any task they need if she's got a spare moment and it makes their job easier... she's a great manager, respectful of the residents, warm with the NACs, manages to keep something like a big picture in her head while performing tasks both detailed and demanding, and man do I wish for the 3rd floor's sake that they'd move her up there for a while.

The first day I shadowed Jane, she introduce me to Kiko, and told me that she and he watch each other's section of the hall when the other is on break. I was pleasantly stunned. No one does this on the 3rd floor, which is why us students had such trouble finding NACs up there--they were on constant breaks, and all together. No LPN on the 3rd floor really directs anyone's behavior or sets any limits. Clearly they wouldn't leave for simultaneous 45-minute breaks if someone noticed and called them on it.