An LPN in long-term care, specifically in assisted living and memory care with active licenses in Oregon and Idaho, Nurse Stephanie Sypher feels heartbroken to see her patients' dementia symptoms worsen and their mentation and self-care abilities decline during lockdowns.

Q: TRUE or FALSE: “Nurses eat their young.” 

A: In my experience, more often than not. After all, it IS a saying in the nursing world. I, personally, have never understood it. Sometimes, it seemed like playful “hazing” to break in the newbie. Other times, it seemed hurtful and wrong.

Why, then, do some veteran nurses choose to engage in such behavior? We all know that a team is only as strong as its weakest link. I have heard comments ranging from, “Well, I'm giving her the chance to dive right in,” to “I did my time now it's his turn, “ and even, “ she can do it, that’s below my pay grade.” 

Stephanie Sypher, LPN

Shocking, I know. I was never a caregiver, or a CNA before I went to nursing school, but I knew the massive amount of responsibility they had. And in my first term of nursing school, those were the skills I learned and practiced. To this day, they are skills I still perform because I am a healthcare professional. I am not above assisting with basic care just because I passed my state boards.

It has always been my opinion that, as a more experienced nurse, it is part of my job to mentor the new CNA’s and new graduate nurses, to give them support, encouragement and guidance while they are finding their feet and figuring out what routine will work for them based on their individual learning and organization patterns. It can be very frightening & frustrating coming into a new job. Fear of making a med error, worried because they aren't even 1/2 way through their first pass and they are running late. 

I have seen nurses who rush their orientee or seem irritated because things are not running on schedule. This creates even more insecurity in that person because that behavior validates the fears they already have. I like to tell them when we start that things are going to take longer and it is EXPECTED. They are learning the patients, the patient’s preferences, location of items on the carts, shift expectations, and so much more. I don't want them to be overwhelmed. I ask them how they feel they learn best so that we approach training in that manner. I’ve had wonderful success doing it that way. 

When they become confident enough to be on their own, I am still there for support. I have been so proud of the progress and confidence my trainees have had. I just recently ran into a woman I had trained as a med tech 20 years ago. She recognized me and as we talked, she told me how grateful she was with the training she had received from me because it had given her the confidence to apply at one of the local hospitals and she was hired! She told me that she uses some of the same training methods that I used. It was really gratifying to hear those words.

I am VERY new to Nurse Deck, but I have to express how impressed I am with the content available and the fact that the general mission is to form a strong, supportive, educational community. That is much needed especially with everything we have been faced with in the last couple years with the pandemic and the quarantines that have left so many, not just healthcare professionals, isolated and feeling so very alone.

Q: What is your specialty and where are you based?

A: I am an LPN and the majority of my experience A: is in long term care, assisted living and memory care. I hold active licenses in Oregon and Idaho.

Q: What does cultural competence mean for healthcare providers?

Cultural competence is of utmost importance for healthcare providers because having the knowledge of the practices of our patients' cultures will enable us to give more effective care. By learning those mores, we can then adjust the manner in which care is given. 

Depending on cultural beliefs, we might choose to recommend a female provider. We may understand that the patients age group is very stoic and “suffers thru” issues without discussing them, meaning we need to ask more open ended questions. We need to listen to our patients and learn not to respond and treat based on our own cultural beliefs.

Q: What is your experience with nurse unions?

A:  I have never worked a union job

Q: What would you say is the single biggest challenge nurses face today?

A: I think the biggest challenge nurses are facing at this time is the disconnect. Especially in long term care and memory care. The social distancing and isolation are extremely difficult in that demographic. It has already been of note across the board that there has been a massive increase in severe depression. 

I can say from experience that it was heartbreaking to see the rapid increase in the severity of my patients dementia symptoms and to see decline in mentation and self care abilities in patients who had been fairly independent prior to the lock downs. It took too long for facilities to think outside the box to find ways to keep these individuals engaged and to help them not feel abandoned. We, as care providers, now appear in full PPE and that must have had an effect on patients' perception of safety. 

Sure a patient of normal functioning could understand the need for distancing and protection, but a person with impaired mental status is fearful because they recognize no one thru all that gear. Their families can’t visit and they can't remember why. They grow suspicious of us and feel like they are being held prisoner. Any patient with hearing loss has the frustration of not understanding because the crutch of being able to see our facial expressions and read lips is now gone as well. 

We have to come up with better methods to communicate and care for those already at risk patients. There are plenty of ways to help while still following infection control protocols to the best of our abilities. Much like very young children, dementia and Altzheimers patients may not remember to wear a facemask. We can remind them, we can redirect them, we can encourage frequent hand washing, and we can frequently sanitize surfaces. 

And if a patient should happen to refuse to mask when out of their room, so be it, we are in full PPE.  The “touchless” hug stations were developed so that relatives could come visit. A plexiglass barrier with a set of bonded shoulder length gloves gave the ability for them to talk to and somewhat touch their families. It helped but not soon enough.

These practices, it seems, are going to be the new normal. There MUST be some serious dialogue and consensus on the degree of PPE required in different circumstances. We now know that people can be asymptomatic and contagious, and we know that vaccinated ppl can still contract it. 

So, if we have no active cases on a unit, staff and patients are vaccinated, would it be allowable to go back to standard droplet precautions (regular face mask, use gloves and gown if coming in contact with fluids) and allow the patients to interact again by having activities set up to maintain distance. Hallway bingo…each patient can sit in the doorway of their room with their overbed table to have their bingo cards on. 

It is important to remember that the bonus is upon us to provide holistic care for this demographic and that focusing only on the infection control issue has created myriad other issues for this already at risk population. It is past time to get more creative in making sure ALL their needs are being met, physical, mental, spiritual..