A Day in the Life of a Licensed Caregiver

Hey, my name is Maria. I have recently upgraded myself from a certified assistant to that of a licensed caregiver. I used to be a Nurse’s assistant. Now I am a nurse. I still work in a skilled nursing facility. Unlike a hospital, most people stay here longer and many of them end up living in one of our floors. Except for a very few, the majority are older adults.
My day starts at 5:00 am. That is the time I force myself to get out of bed, go to the shower, wear my scrubs, have a quick breakfast and drive myself to work. No need for make-up, intricate hairdo, fancy jewelry, or high heeled shoes like office ladies do. Our pajama looking outfit takes away the headache of clothes selection. At around 6:00 am, I am on the road, hoping not to get entangled by traffic, road construction or vehicular accidents. Behind the wheels I start thinking about the residents on my floor. As a newbie, they have me floating around after only a week of training. This week will not be easy. Third floor is almost like an intensive care unit. I will be taking care of 24 residents with the help of only three assistants. Twenty of my residents are diabetic. Five have gastric tubes connected to their bellies because their eating mechanism is messed up. Six are on oxygen concentrators with a cannula on their nostrils to help them breathe. Seven are connected to a pump that drains an open wound. And all of them are cognitive.
6:45 am – I finally arrived at the parking space. Work starts at seven. I got off the car, picked up my tool kit, straigthened myself and clocked in 5 minutes early. Since elevators are usually slow, I took the stairs. The sleep deprived night shift nurse is still going around giving the last round of medication to some of the residents. In my shift, the first round of drugs does not start until around 9:00 am.
7:15 am – “Mrs. Smith in room 315, bed 1, scratched her hemodialysis site last night and she was bleeding. We caught her on time. Please keep an extra watch on her. Mr. Thomas in room 320, bed 3 has a slight fever last night. I gave him some Ibuprofen. I just checked his temperature. It has not come down. So please do it again after an hour. They said that at around 10 am, there will be a mock survey. All the consultants are around checking on nurses. Mr. Brown in room 325 has…” This is the endorsement part. So that residents can be taken care off properly, the outgoing nurse should tell the incoming about changes or events that have happened. Of course, we mix it with chit chat and what not. Otherwise, we sound like reporters giving a dry and boring news report.
730 am –I have taken hold of my territory. The night shift nurse is gone. I am now in charge. I had to go from room to room, my first round of a general inspection. I want to be sure that no one fell, injured himself or died while I was chatting with the other nurse. Although we did not hear or see a single call light and no bed alarms sounded off, we cannot assume that all residents are fine. Despite their limited abilities and disorders, some are capable of disconnecting tubes, turning off devices and handling controls to the point that they fall when they attempt to stand on their own. “Good morning, Mrs. James. Did you sleep well last night?” I asked a disheveled lady whose eyes were still half closed. “Get out of my room!” she responded. There goes my early warning.
8:00 am – I am an hour before I give my first round of medication. After making my rounds, I checked the atttendance of my assistants. All were there. I divided their work for showers, feeding, and other family instructions. In this job, we do not only handle sick residents. We also handle their family members, some of whom have a very sick disposition of expectations. Although there are those who are really nice, there are some who always talk, whine or complain. They seem to have adjusted their vision to focus only on what is wrong and what is lacking. Sometimes I wonder if it would be a good idea to give them some PRN Ativan to doze them off a little. An hour early and an hour late are the acceptable parameters for pharmacological administration. My countdown has started. Crushed, whole, injected, applied or mixed are just some of the things I do before a resident consumes his drugs.
9:45am – I am almost done with the first round. “Third floor nurse, please pick up extension 02”, the reception’s voice sounded through the paging system. “Hello”, I said. “This is Dr. Abdullah. I just read the lab results your night shift nurse faxed to my office. Mrs. Thornton’s leukocytes besides other things are not good. Send her to the hospital ER immediately”. “Yes Doctor,” I said. I was about to ask something else, but then the phone clicked. Documentation, ambulance phone call, and preparation of more documentation followed after this. Meanwhile, “beep, beep, beep”, 330 bed three was calling. Fortunately, a CNA was there…..
2:30 pm – I have an hour left before I go home. Yes, I was able to give medication to all my residents without any incident. And I was able to provide treatment to those who needed nursing treatments. Those who were scheduled to have a shower had a shower. Those who had appointments for outside lab work were all sent without delay. I had my share of unpleasant family members but such is the daily ritual of our routines. I only have an hour left before my day ends. I can afford to do another round. My residents have finished lunch and many of them are just sitting around or are being tucked in bed for their afternoon nap. I looked at them. I know that some day in the distant future, I too will reach their age. When that day comes, I wish I could have a nurse like me, someone who does not care much about how much we make but more about what we make from the things we do. Despite a flood of nursing students and nursing schools, entry level nursing, among the licensed and the registered within the health care business, is still the lowest paying job within the industry. It will take some years of experience and more college loans before we get on par the other licensed or registered workers of the health care sector.
3:15 pm – I gave the endorsement to the incoming nurse as I received mine this morning. Despite the more than 8 hours that passed, my day was fast and short. After my endorsement, I walked around for the last time, trying to be sure that each and every resident is fine. “See you tomorrow, Mrs. Jones”, I said goodbye to a resident. With a soft voice, she said, “Thank you” then closed her eyes for her afternoon nap.
3:30 pm – I clocked out, walked towards the parking space and drove my car. From my rear view mirror I read the words, “Skilled Nursing and Rehab” posted at the top of the building. I was tired. Nothing exciting happened. My routine was drab and seemingly boring, yet the human beings under my care had another day of life. And I pray that their life is not a mere existence, but that of expectation and a hope that tomorrow could always be better. I end with what I wrote in my nursing notes: “I will follow up”.