Why do I work here - services of nursing homes

Nursing Homes, August, 1999 by Pat Holland

Sitting in front of the TV watching another negative story on nursing homes, I find myself questioning one more time, "Why am I still working in a nursing home?" Everywhere I turn - on the news or in the newspapers - all I hear are the bad things about nursing homes. Why do I continue to deal with government regulations, corporate headaches, combined with the numerous human relations issues relating to parent/child, illness/disability, quality of life and aging?

There is only one answer - my residents. My residents average five major diagnoses each. They have as many different personalities as anyone in the community and are facing some difficult times in their lives. They have faced the death of soulmates. They've surrendered their independence and now live with a roommate in a congregate setting. They've left the homeplace because of disability.

These are just some of the challenges facing not only the residents but also many others with handicaps and/or aging-related problems.

Our task in the nursing home is to help our residents function to their highest practicable level. We deal with their medical, social, psychological and ethical situations as conscientiously as possible and explore innovative approaches to make each resident's life meaningful. We achieve these goals many times over.

To one resident it might be the ability to have a feeding tube removed and return to eating regular food. To another it might be walking again after a stroke. It might be as subtle as a resident's smile, an achievement when you remember how depressed he was when admitted. Another might demonstrate her creative abilities by writing articles for our newsletter. It might be keeping a bedside vigil as a resident makes his final journey from this world.

Despite the successes, there are many problems that are difficult to control in the nursing home population. The wandering resident is one. Nursing homes can only lock a unit if it is strictly an Alzheimer's unit. Government regulations prevent us from using restraints to prevent wandering. Often we do not even know if a resident will wander until he actually does. The dilemma is how to safely manage this resident within the rules.

Another difficult situation involves the resident who refuses to eat or who eats poorly and has exhausted all therapy options. Artificial feeding is not a cure-all for this problem and is not desired by some residents and their families. The results of poor nutritional status, which is also seen in 30% of community-dwelling residents as well, can lead to other difficulties, such as renal problems, bed sores, confusion, dehydration, etc.

Our dilemma, as nursing home employees, is how to balance these issues and create a successful outcome for everyone. We wish we could make everyone walk, talk or even go home again if they wish. Our frustration is that this is not always possible.

I remember why I'm still working in a nursing home. A resident summed it up for me. He was excited because one of our nurses was taking him bowling that night, and he had just been given his own personal copy of a special magazine. He turned and in his slow, halting voice said, "Thanks!" I said, "Thanks for what, Mr. B?" He said, "Thanks for making my life full."

Pat Holland, RN, C, LNHA is administrator of Britthaven of South Louisville Nursing Home, Louisville, Kentucky.