We’ll make a fortune …

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I’m bending down to retie the shoe of one of my residents after breakfast. As I do so, she starts stroking my hair.

“Nurse Dux, you have such beautiful hair!”

“Thanks, Ella, that’s nice of you to say so.”

“It’s so soft … it’s very shiny … Oh! … We could sell it!”



Get me the alligator gun …


I’m in need of a bigger alligator gun. I am up to my ass in them, and they think they’re winning.

I’m providing nursing care for 42 residents in a two-building, 60-bed facility. They are all here because they failed placements at other facilities for behavioural reasons. Lots of LTC facilities have “memory units,” and take demented old Granny as long as she can pay. But as soon as she starts screaming at the wallpaper, eating off of everyone’s plate but hers, delivering poop presents to staff, peeing in the fireplace, and getting naked before arts and crafts, they send her packing.

That’s where a facility like this comes in. It’s set up to safely house and care for the soon-to-be-homeless schizo seniors, the demented dodderers, the hitters, the kickers, the spitters, and the screamers. The youngest residents are in their 40s, the oldest in their 90s. Some have as many as 12 failed placements before they end up in a facility like this.

I spent the day wheedling med orders out of distant docs. I was polite when I told one doc that her wound care order was [barbaric] and 50 years behind the times. I shoveled one resident into a cab three times, only to have her exit out the other side three times. I finally had to send for a cab with lockable doors. My staff is uneducated, and although some have potential, some need to find other jobs. I have conversations that involve invisible refrigerators (it was in her stomach), “purple sixteens,” the people in the television [off] who tell them to not take their pills, poisoned food (the “twelve-inch people” do it), and missing hair. One resident called the police on me today when I wouldn’t get her a pregnancy test (“Polly, you’re 81 and you yell ‘whoop! whoop!’ every time you poop. I’m not thinking the guys around here are lining up outside your door at night to do the granny-hop with you”).

My first week in the new job as DON – 60+ hours – I spent defending the facility against a Statement of Deficiency from the state that ran 76 pages (it arrived Monday afternoon, my first day). Six IJs (immediate jeopardy tags), and 21 other nursing citations – the state closed one of their  buildings to new admissions. I had no idea that on my first day as DON I would go from the frying pan into the fire. I had to write a policy manual for the facility from scratch, and provide the nursing care for 42 psychiatric and advanced dementia patients (four of whom I discovered had pressure ulcers; there would be more).

At the end of two weeks, I was fried. The weekend came, and I tried to crawl inside a scotch bottle and hide. It didn’t work, Monday still found me.

Not all it’s cracked up to be …

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Being the Director of Nursing for a psych facility is not the cush job it first appears to be.

  • 0625. Arrived at the facility. Met at the door by two NOC staff with their updates, complaints, and emergencies.
  • Five eloping patients tried to leave over 100 times during the day shift.
  • Four resident assistants reprimanded for leaving door alarms unarmed.
  • One computer meltdown finally fixed after four days with no connection.
  • One dying patient in pain and with sinking O2 sats assessed and comforted. Hospice notified but tells me “We’re pretty busy today, can you handle it?”
  • Two crisis family meetings.
  • Four missing syringes of morphine.
  • Nine calls to the VA and hospice to order more morphine.
  • One meeting with a parole officer, one meeting with an angry parolee.
  • Five calls to MDs to adjust meds.
  • One resident transported emergently to the ER for chest pain.
  • One solid beating of the DON (me) by an angry bipolar who wanted to leave the back yard. One pair of broken glasses.
  • One new exterior gate latch purchased and installed by the DON to prevent further back yard escapes.
  • One trip to Shopko for toilet paper, butt wipes, and gloves.
  • One extremely unsavoury coccyx wound repacking on a screaming resident.
  • One hemorrhoid tucking for a resident who’s spitting on me.
  • One call from and collaboration with an ER doc.
  • Nearly 400 meds found in a closet from 2010 logged in and destroyed.
  • Over 110 HIPAA act label violations found in a mailbox and remedied.
  • Two missing psychotropic med scrips tracked down and original orders refaxed to pharmacies.
  • Two wound care packages ordered.
  • Two staff fights refereed, the staff’s July schedule approved, and three more staff schedule disagreements handled.
  • Another 150 pages of protected patient information shredded.
  • 26 residents rounded on twice.
  • Multiple hugs administered.
  • Office chairs cleaned of resident urine twice.
  • Cellphone located in resident’s shoe.

1855 heading for home. Day 19 in a row without a day off. My cellphone rings before I even leave the driveway.

I do not believe in the full moon effect …

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… but I have had to initiate two emergency detentions in the last two days.

Things I have learned as a Director of Nursing in a locked psych facility –

  • Patients never schedule their psychiatric crises during daylight working hours.
  • People who have normal jobs aren’t on a first name basis with the county mental health crisis center workers.
  • The top places on your cellphone speed dial should be assigned to folks who wear badges and arrive with lights and sirens.
  • If you can get to the facility before the news media does your life will be infinitely easier.
  • The corporate owners really don’t want to know that everyone’s safe – they just want to know how fast you can get a cost estimate on any damage.
  • It’s not polite to roll your eyes at nurses who tell you their day was horrible because they had to give an enema.
  • Kids who know how to cook dinner for themselves – and keep a plate warm for you, too – are worth their weight in haldol.

Caught in a landslide …

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… no escape from reality.

Every day, in every way, my life just keeps getting better and better. Being on 24/7 call as a Director of Nursing in a locked psych facility has its moments.

[It’s 1820, I’ve been home for five minutes, and Queen’s Bohemian Rhapsody – “Is this the real life? Is this just fantasy?” – sounds from my cell phone. Duty calls.]

“Hi, it’s Dux. Does whatever you’re calling about involve smoke, open flames, blood, or dead animals?”

“uhm, no.”

“Good. What do you need?”

“Julius has barricaded hisself in his room again. He won’t come out for meals, and he’s mad – every time we knock on his door he opens it and throws a cup of piss out on us! What are we supposed to do?”


“Stop knocking on his door.”

Some problems are easier to solve than others.

Road Runner …

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On our hospital paging system we have a variety of message choices, among which are “Bedpan,” “Blood sugar,” “Assist,” “Turn patient,” “Equipment beeping,” and so on. If a nurse passes any room and hears beeping, she’ll go in, identify and usually fix the problem as necessary (adjust an IV, restart suction, tell the patient to take a few deep breathes, lunch is on its way, etc.). That way the beeps are fixed and we’re not continually answering “Equipment beeping” pages.

Now normally, the unit’s nurses will just go in and take care of the problem on the fly, and we’ll only tell you about it if it is something you need to chart or put on your to-do list for later in the shift (like a bag of IV fluids that will need replacing). But for the past few days, my fellow employees have been entertaining themselves by telling me, “Room 58’s beeping again,” then walking away laughing.

It’s the damned patient. He’s an 85-yo dementia patient who sits in his bed intermittently going, “Beep! Beep! Beep!” all frickin’ day long. But honestly? I’ll take a beeper over a spitter any day of the week.

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