Geriatric Nurse, Senior Day Health Program
The Story: Luckily, as a result of being refused entrance to a hospital school of nursing at seventeen, I later graduated from the University of California in San Francisco (UCSF) with a BSN, RN, and Public Health Nursing certificate. This story is a description of my 10 years as Director of Medical Services (think Head Nurse) at a community-based, free-standing, day program for the "less-than-independent" elderly. These years (1986-96) happened to coincide with my vision loss due to low tension glaucoma, its treatment, and Sjogren's syndrome.
My sighted nursing experiences, which took place before leaving the country for five years to sail around the world in a 40-foot boat with my ex-husband and two children, were as charge nurse in a pre-natal clinic and a night float nurse at Stanford Hospital. Soon after returning home I discovered a new program within walking distance of our house. It had one RN and looked interesting so I volunteered at the senior center where I monitored patients' blood pressures while working part-time at a small clinic. Then one day the Senior Day Health Program requested temporary help from the senior center and I was ready!
When that temporary job finished I became a back up RN and occasional volunteer nurse. There were two of us who enabled the full time RN to continue in place (and as my mentor!) for another 6 months despite her increasing health problems. When she had to quit, I was offered her job and then worked to obtain Certification in Gerontology from the American Nurses Association (ANA). Six months later I noticed significant loss of visual field and my eye condition was diagnosed.
Being Director of Medical Services involved many responsibilities and tasks from writing policy and creating forms to assisting participants in the bathroom. The core of the position was direct nursing—assessment, creating a care plan, and carrying it out with medications and treatments. Along with being in charge of our team, consisting of an occupational therapist, physical therapist, speech therapist and aide, I worked closely with the program director, activity director and social workers. Coordinating the paper work from the admission information written by the primary care physician through the Treatment Authorization Request for approval for Medicaid payment, regular consultations with the pharmacist and registered dietician and, periodic presentations to the Utilization Review Committee as well as preparing for yearly state inspections, all fell within my charge.
A typical day might involve pouring medications, doing an assessment, calling doctors about their patients, calling families, teaching a blind patient ways to identify medications, reassuring an Alzheimer patient that the van would come, and answering multiple questions from staff and participants. Team meetings and charting, in addition to giving weekly talks to the participants about the human body, also occurred routinely. Occasionally I had nursing students as part of their community rotation or oriented medical students to the setting.
As the years went by the job became more challenging resulting in the need for rehabilitation services. My vision decreased but the daily attendance acuity level increased. With help from the rehabilitation agency and the cooperation of the Executive Director, in 1991 I was given a CCTV, a mobile magnified lamp, and once I obtained a computer for the nursing office, ZoomText to enlarge the print on the monitor. Unfortunately, I had to threaten resignation to get the computer. I had been using my home computer to make large print forms, order sheets, etc.
As I learned about the importance of contrast, I asked the professional staff to assist me by using special pens and forms which the secretary helped me produce. I learned to schedule reading tasks around my glaucoma medications to take advantage of clear vision times and did the teaching later in the day. I later obtained O&M training from Peninsula Center for the Blind and Visually Impaired (PCBVI). I needed to use a cane at work because of all the wheelchairs and walkers. One of our more aware participants would find my cane for me whenever I would lean it against a wall to give a pill or do other tasks. One Alzheimer patient asked if I was herding sheep! I next took braille classes along with one of my participants, while my back up handled the program. I used braille to mark files and so forth. One of the van drivers kindly built an adjustable copy holder so I could write with the copy closer to my eyes. As the attendance rose, I developed a position for a Licensed Vocational Nurse (LVN) and we hired more program aides. The newly filled positions relieved me of much of the need to help participants in the bathroom; however, I had other more complicated care plans.
The job was one I loved—it was a challenging position. Learning about a variety of diagnosis, the heterogeneity of aging, and making a difference in the participants' lives; bringing changes to the attention of the doctors, curing "chest pain" or "abnormal gait" as reported by social workers or drivers by turning around a bra or switching shoes was fulfilling. Actually one aphasic participant one day pointed out to me that my own shoes were different colors! We were successful in our mission to postpone institutionalization. However, by 1996 I had even less functional vision and was fatigued from the Sjogren's. A second attempt at further accommodations recommended by the rehabilitation agency was denied by the Executive Director. My volunteer and back up nurses kept me in place for another 6 months so I could use up my accrued sick leave. Then, I quit and attended the Orientation Center for the Blind.
Nowadays I am a member of the Board and Coordinator of the Health Library at Peninsula Center for the Blind & Visually Impaired. Looking back on my career I see that my basic and continuing education coupled with each nursing experience built one upon the other to enable me to prepare for the next adventure with savoir faire.
Nursing has been a rewarding adventure which I continue now as a 68 year old volunteer running a diabetes research list on-line and doing health searches for the blind and visually impaired community. Using WindowEyes, OpenBook and the many techniques I've learned, facilitates these activities. Nursing is primarily a knowledge-based profession and dependent on the brain not the eyes. Once you are a nurse you have the tools to work in many fascinating positions. Bon Voyage!
The Contact: Dawn Wilcox