workin’ hard for the money

SO HARD for the money.

Seriously. So. Freaking. Hard.  I’ve put in more 9, 10 and even 11-hour days than I have 8-hour days, mostly because there is just So. Much. To. Do.  And a pretty steep learning curve at that.

But, I LOVE my job.  I love being able to walk to work, my co-worker is perhaps the best teacher I’ve ever had (and so patient!), everyone is nice and I love bringing a smile to the residents every day.  So, I’m really hoping these hours improve, and FAST.

Actually, the kicker isn’t really the hours themselves (I’m sure many of you–including my husband–regularly work more than 8 hours a day), but that I have evening activities four out of five nights each week.  To say it’s been hectic lately is an understatement.  (Throw in a traveling husband, a fence in progress and a truck in the shop more than it’s been out, and you have downright insanity over here.)  Case in point:  it’s taken me five weeks to actually write this post (and the only reason I’m writing it now is because it’s midnight and I have insomnia).

Back to the job.

I always said I’d never work in long term care, but I’ve been pleasantly surprised at how much I enjoy it so far.  Again, all my co-workers are great, and I like that I get to see familiar faces all the time.  I have two different units: the rehab unit, where people come in and out within about 3-4 weeks, and two floors of dementia residents, who are long term. It’s been fun to start ‘getting to know them’ as well.  The units couldn’t be more different, and the workload certainly keeps me on my toes.  Thankfully, the rehab unit is just around the corner from my office, which is convenient since it’s my busiest.

In case you think I’m dishing out food during lunch or telling residents what they can and can’t eat, here’s what I DO do:

-monitor all the residents’ weights on the monthly (or in some cases, weekly) basis and track gain and/or loss trends; if there are significant changes (based on specific criteria), I make meal plan changes and initiate an intake study (in which I observe their trays after meals to see exactly how much of each item they ate and calculate their approximate intake of calories, protein and fluids), chart on EVERY weight

-admit new residents to rehab, at the rate of approximately 1-2 per day (a short interview with them if possible, fill out a dehydration risk assessment, ensure all their information is correct in the computer that ‘talks’ to the kitchen, write a progress note and put in their diet order)

-complete 14-day admission assessments on new residents (longer forms in our EMR with questions on everything from a residents’ weight and height to their nutrient needs and medical history, all of which I have to hunt around in the EMR), as well as quarterly, annual and significant change assessments for long-term residents

-fill out about a bazillion ‘MDS’ forms (forms for billing) in our EMR for residents based on their insurance and time at the facility (5 day, 14 day, 30 day, change of treatment, discharge, etc) based on the four ‘lists’ for my units

-sort through and alphabetize hard copy lab work each morning so I can grab them when doing assessments

-address any concerns about a residents’ diet, intakes, weight, etc… addressed during our morning meeting…or anytime our phone rings in the office

-monitor residents’ hydration status and figure out the average intake for the handful of residents who don’t have sufficient fluid intakes, write notes in the computer AND hard copy to be addressed at our weekly skin and hydration meeting

-monitor any resident with a pressure injury (order them a supplement, start an intake study, fill out a calorie-protein worksheet in the EMR to figure out their nutrient needs)

-try to stay on top of the food and fluid texture and consistency changes that our speech therapists recommend based on a residents’ ability to chew and swallow

-attend weekly care plan meetings for my units, as well as any family meetings that have been scheduled

So yeah, it’s pretty busy in our office.  There are two of us who cover about 120 residents each, and a part-time RD who works two days a week and covers two smaller units of about 40 residents total.  I’m just about convinced that there is more work than anyone can do in an eight-hour day, especially with the rehab unit.  But, my efficiency does improve a little each day, and I’m learning pretty quickly.  Thankfully, there are so many things to like about my job that the extra hours (at least while I’m there) aren’t that bad.  Hopefully, once I get caught up and can get out from under the pile of assessments on my to-do list, I’ll be able to get a better handle on the workload.  Until then, my nose is to the grindstone!


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