how to be a geriatric nurse

Unfortunately this was the scene

Like 30 years ago. And today. 

Folks sitting in wheelchairs 

All around the Nurses Station

Or lining the hallways. 

Waiting for meals. Or Bingo. 

Nursing plods along 

And change is often slow. 

Big changes take a generation. 

We all get old. 

Why is this field so neglected? 

I promise you- most Nurses hate this -

And Nursing Homes are the

 Bane of our existence. 

Slight improvement from the 1950s 

People are living longer. 

(Sometimes) 

With improvements to life. 

(Sometimes)

What have we created? 

Definitely room for improvement. 

Many Nurses will start their career here- 

At a LTC Long Term Care Facility. 

I know I did for sure. 

They pay more than Home Heath. 

So so so many meds. 

In order to be eligible to live 

In a “Nursing Home”

Now referred to as Nursing Care Centers 

Or ReHab.  Or Assisted Living…

To qualify, a person needs to 

have a medical need. Like a diagnosis,

Or multi medications. 

Some need. Nursing always 

addresses a need. Why are we there? 

What are we doing for the patient? 

Group Homes are also nice. 

Usually Private Pay, though. 

Sad fact is that most places are 

Sadly understaffed. 

And regulated to death. 

For example:

I worked in one such place 

That used the wrong fasteners 

For the hand rails- in the hallway. 

The State closed them down

like they had the plague. 

BUT the rails had already been up 

Literally for decades. 

Suddenly they focus on that

Instead of the bigger picture. 

In a standard Skilled Nursing Facility 

Aka Long Term Care Center, 

Each Nurse has a corridor 

Or part of a hallway to cover. 

A Nurse can have up to 30 patients 

In this warehouse of human souls. 

There little time for care. 

This is the Charge Nurse. 

S/he has several CNAs

(Certified Nurse Aide) working. 

They’ll take the vital signs,

Do the bathing, personal care,

[Nurses call this ADLs-

Activities of Daily Living]

And help with meals. 

The Nurse will pass meds,

Usually 2 times a shift. 

Give insulin, oversee care,

And wound care … etc.  

You can probably guess- I’m a fan of 

Reforming the whole system. 

It’s sadly broken. 

Now it’s our turn to take care 

Of our parents. 

They call it a Sandwich. 

You’re smack dab on between

Raising your own kids - and 

“Raising” your parents…

That is, tending to their needs. 

I can’t imagine this life for me. 

Or anyone I love.

But it’s great if you have no other options. 

Some residents have rich fulfilling 

Friendships and receive good care. 

Some fancy LTCs require $100,000

Non Refundable Deposit- 

Just to be on the list. 

$1000 a week is starting cost. 

On the low end. 

Anything for Dad, eh? 

Especially if it’s his money! 

Private pay Nursing will charge 

$1000 a day for 24 hours care. 

That’s not what the nurse gets paid. 

By the way.  Drats. 

This is why we preach prevention. 

Being strong and healthy. 

I’m not rich. But I’m healthy. 

And that’s infinitely better! 

The expectation 

VS the Reality of aging. 

Into this mix of Adult Diapers, 

(It’s a no-no to say diaper. 

We say “Briefs;” Babies wear diapers.)
Chronic illness, loneliness and heartbreak 

God sends His Nurses. 

Most Nurses don’t last long in what

can be truly deplorable conditions. 

I’m ready for reform! 

A new kind of place for mom. 

how to be a psychiatric nurse

Not much has changed,

It seems, in Psychiatric Nursing 

Since like the 1950s. 

It can be a real Snake Pit. 

What has changed, is that 

We’re moving away from 

Old Institutions- with indefinite stays. 

The stigma is being challenged. 

Psych Nurses wear street clothes 

Usually- I worked adolescent psych

When Kurt Cobain killed himself. 

I worked so much it was “crazy “!

In the Mid Century, Doctors 

Thought they had it right. 

All new treatments, medicines.  

But now, those things seem barbaric. 

Most of those first-generation 

drugs are now discontinued. 

John Nash, mathematician 

(A Beautiful Mind)

Is seen here receiving Insulin Shock. 

They inject large amounts of insulin, 

The patient goes into a coma,

And glucose is given to revive them. 

It’s often used with ETC

Electric Shock Therapy. 

The Frontal Labotomy  

is never used nowadays. 

Thank goodness. 

Wikipedia say this era represented 

“The moribund and demoralized 

psychiatric profession at the time.”

The Glory Days of the Sanatorium. 

What the hell did this ever accomplish?

My first “real job” was at Timberlawn

Psychiatric Hospital. Here in Dallas. 

Every summer until I was old

 enough to be a Nurse Aide. (18)

I worked in Medical Records 

I worked in a literal basement,

Re-jacketing the old charts from the 1800s

And early 1900s. Cool history. 

People want their loved ones home. 

Placement is falling out of favor. 

Except for short term stays 

And emergency situations. 

Lots of new drugs. 

Anti-depressants,

Anti-anxiety meds,

Anti-psychotics. 

Lots of side effects, most mild. 

It’s interesting to note that most

Psychotropic drugs are only

tested for a few weeks. Or months. 

Yet, many people stay on them for decades. 

Then, there is “Dual Diagnosis”

Which is a chemical addiction 

Coupled with a chronic psychiatric condition. 

The gentle idea is that people are 

Looking for a way to self-soothe. 

And they get into all kinds of drugs. 

And why not? If doctors can’t help,

People turn to anything that will. 

Regular Rehab is a good career option.

Lots of people just wanting to quit

And they don’t want to go Cold Turkey. 

Most people are there voluntarily. 

It’s definitely a reflection 

of how society is changing. 

Not too long ago, the DSM 2

(Diagnostic and Statistical Manual)

-The Bible for psych - 

Listed homosexuality as a mental disorder. 

The transgender community used that model

To destigmatize and decriminalize 

Their perspective. 


Trends come and go in psych. 

Multiple Personality Disorder, 

Personality Disorders, 

Schizophrenia,

BiPolar Disorder,

PTSD,

ADHD, OCD,

Suicidal Ideation,

Even Eating Disorders. 

Geri-Psych, Memory Care 

My heart goes here 

Because of the possibility of change. 

We’re poised to make a difference. 

Will this be the generation 

Who finally embraces change? 

Psych Nursing is real Team Nursing

You’ll never walk alone when you’re 

On a psych ward. Amen. 

how to be a pediatric nurse

Pediatric Nursing is its own entity. 

It’s rough to see pictures of sick kids. 

But this is what we’re all about. 

We focus on the healing. 

Not just the pain. Disclaimer. 

Antley Bixler Syndrome. 

Omphalocele

Liver or other organ 

Is external at birth. 

Tracheotomy (pronounced traak) 

Is common with kids. 

Kids aren’t very good breathers sometimes. 

Think about it. Snotty noses = kids. 

Kids with trachs don’t always have a vent. 

But some do. 

Some just use it at night. 

Some - all the time. 

We think quadriplegia is total paralysis. 

Or that you have no feeling in your limbs. 

Not always. 

Functional quadriplegia, spine issues, 

Kyphosis, scoliosis, lordosis…

Subluxation of the hips…

Joints dislocated…

Lots of Ortho. 

Lots of Speech Therapy. 

We ❤️ Scottish Rite Children’s Hospital. 

Dallas is lucky. People come from 

All over to get treatment from the Shriners. 

They have never charged a dime 

For any service provided to any child. 

Little hands need lots of love. 

Kids don’t know they are sick! 

They don’t know what comes next. 

Kids need extra movement 

And range of Motion (stretching)

Because the bones can grow faster

 than the muscles- which pull-

And contractures develop. 

Kids should not have to face such things 

And yet- here we are! 

Kids with burns. 

Kids with cancer. 

Fat kids. Skinny kids. 

Kids that climb on rocks. 

Munchhausen By Proxy. 

Child abuse. Even terrorist attacks. 

Kids that are trafficked for sex. 

Kids that give birth to babies. 

Kids with COVID- HIV- etc. 

We stand beside them all

And protect and guide them. 

*Clara Barton. Nurse during the Civil War.*

Into this terrifying mix, 

the Nurses go-

Because we know we 

Can and DO make a difference. 

Even a wee difference. 

No life is too wee to have love. 

how to be an Army Nurse

The Military have a special place

In American Mythology 

And history - and Nurses helped!

First step is to see an 

Army Recruiter. 

They’re the ones who actually 

Navigate through the maze. 

They’re in shopping malls

And they’re ready to serve! 

Anyone who wants to be an Army Nurse-

Must then take the ASVAB

[Armed Services Vocational Aptitude Battery]

To see what you’re capable of. 

It’s like an IQ test. 

Perspective Nurses must score 

in the top 1%  of all testers. 

Then comes Basic Training. 

That was like 10 weeks - all told. 

And it’s designed to be hard. 

Push-ups, 2 mile run, gas chamber…

Bivouac, shooting, all the stuff. 

Advance under live fire. 

Obstacle Course. 

I was a Squad Leader (2nd squad) 

During Basic Training.  

Basic can be a lot of fun! 

Then comes AIT. 

Advanced Individual Training. 

You train for your MOS - your job. 

For Nursing, you must first be 

A Combat Medic - which is

An EMT in the civilian world. 

It is a 16 week course. 

The Army Licensed Practical Nursing 

 Program is a 12 month course. 

It’s accredited and licensed 

Just like a university school. 

Clinicals. Classwork. Math tests. 

Every week there were tests. 

Pass/Fail/flunk out. 

We lived on base and ate at the Chow Hall. 

We had very few responsibilities 

Outside of school. 

I trained at Fort Bragg, North Carolina. 

It ran like a well- oiled machine. 

With 82nd Airborne and Special Forces. 

 Our barracks were right in between!

Guys would crawl up the walls 

3 flights up - to see their gal-

Then jump way down and run off. 

But I digress! 

Once you pass the program, 

Then comes the State Boards. 

Fly on through that -

With your excellent training 

And winning confidence-

And you will be a Nurse! 

A real Nurse. Let that soak in! 

And then it begins. 

I sat for the Boards in North Carolina. 

But they’re standardized 

For every state. Once you have 

you papers in hand, you can transfer 

To your state of choice by Reciprocity 

Agreement or by Endorsement. 

40+ states are Compact States. 

Your license becomes a passport of sorts- 

So you can work anywhere without any hassle.

Just a few documents to sign. 

Especially with COVID 

Travel Nursing is so hot right now!

We were Deployed about a month 

After the State Boards to the Gulf War. 

The Army spends several 

hundred thousand dollars training Nurses. 

We sometimes go to the Front Lines. 

You *might* get shot at. 

You *might* not! 

But Nurses are Non-Combatants. 

So a Nurse might end up in a MASH unit. 

I was in a General Hospital. 

A Stick and Brick building. 

I wore a white dress Army uniform 

most days during the Gulf War. 

I was stationed in Frankfurt, Germany. 

And I drank beer after my shifts!

The only difference between civilian 

And military Nursing School, is that our 

Nursing Cap is made of Kevlar. 

In California and Texas, 

It’s a Vocational title. (LVN)

Everywhere else’s it’s a 

Licensed Practical Nurse. (LPN)

It’s just a name. 

It’s the exact same job. 

Same license. 

In the Army, officers are RNs. 

And enlisted personnel are LVNs. 

The LVN almost went away!

It was being replaced by Vocational RNs. 

(Not 4 year BSN)

The 2 year Associate Degree 

But now thanks to COVID,

LVNs are very much in need! 

If you enroll in civilian RN school

The first 5 years after becoming an LVN,

You can “Bridge” to RN. 

You don’t have to start over 

Completely. Just do clinicals,

Some extra classes, 

And sit for the NCLEX -RN 

Many many many Nurses bridge 

And work as an LVN while in school

For RN. Great experience. 

There are only 2 things an RN

Can do that an LVN can’t. 

1. Hang Blood. 

You need 2 people to verify

And one of them must be an RN. 

2. Initiate a Care Plan. 

I’ve written Care Plans for 

An entire hospital! 

But an RN starts the care plan. 

And I’ve hung blood many times. 

I’ve even Pronounced death,

By RN Delegation. 

Thanks for reading! 

This is part of a series on Nursing. 

From my mouth to your ear. 

My hand to your eye. Lol. 

This is Dorothea Dix,

Army Nurse