Just call me Lawrence - Don't judge a book by its cover!

Being sent to different nursing homes is starting to become the normal way of working now. Charisma from the nursing agency has sent me somewhere different again; and so I’m getting used to starting from scratch every few shifts.

This time it was on a unit in a ‘challenging behaviour’ home she was sending me to, and I could almost feel her glee as she imagined them chewing me up and spitting me out.

She likes to label does our Charisma, what with her 'EMI' and her 'challenging behaviour', maybe the agency ought to send her on a course labelled 'Challenging ignorance – for dummies who misjudge other people’?

So I arrived at this new nursing home and as usual headed straight up to the nurses office. My welcome could only be described as frosty, as this huge bear of a man, wearing a belt full of keys like a prison warden, looked at me in surprise for what seemed like a full minute. He then proceeded to bark at me in a confused way asking who the hell I was?

The thought of right away legging it flashed through my mind but I mustered my composure and told him "my name’s Florence and I’m the agency nurse here for my shift”. He relaxed for a second but then all of a sudden exploded into fits of giggles; I actually physically jumped a little, it was really a bit weird to hear such high-pitched tones coming from such a giant.

Anyway, bottom line was, it was a male only unit which meant male only residents, male only staff, male only visitors, male only flies – you name it, it was male only. “We were expecting someone called Lawrence" he boomed and then told me that beggars couldn’t be choosers and that I would do.

To be fair he then gave me quite a thorough handover; he told me the diagnosis’ of all sixteen residents and what triggered each and every one of their ‘challenging behaviours’. A total of sixteen different sets of behaviours, each with a multitude of triggers and also calming behaviours (for which I was to become very grateful). I scribbled everything down frantically in my note book, desperate to remember as much as possible.

Then he showed me around the unit, now that was a real eye-opener. Did people really live like this? The walls were bare, the noise just from people walking and talking echoed down the empty corridors. When we got to the lounge I couldn’t believe it. There were no curtains, just plain blinds. The tables were bare and there was absolutely nothing to do.

Sixteen residents sat in plastic chairs watching a huge television that was screwed to the wall. When I say watching, I mean heads pointed in the general direction of. It seemed like their minds were focused on anything other than what was in front of them and I couldn’t blame them. Why grown men would be watching CBeebies I have no idea.

The male-only staff stalked around them like prison guards, almost like they were waiting for something to happen; it was hideous.

I took the keys off Papa Bear and hustled him out the door. I don’t have much of an idea of dementia and challenging behaviour but I did know one thing, all sixteen of those residents were human beings.

I gathered my team of carers and asked them if there was anything else I needed to know from their point of view. Since there wasn’t, I told them that we were going to do things a bit differently today. If everyone was already up and dressed then we were going to get on with having a nice day. I was met with silence; I could see them weighing up whether I was serious or mid nervous breakdown.

I knew from the handover that the resident’s natural routine is to be up early and so most of them had already had their medication as per timed regimens before breakfast, meaning my morning medication round wasn’t going to be too heavy. So I said the first thing we were going to do was lay tables, get breakfast ready and then serve our guests.

The carers properly thought I’d lost the plot but played along anyway. An hour later every resident was full and the only challenge that had been put in my way was deciding whether to have bacon or sausage on my break time butty.

Later that day I picked the lock on the activity cupboard and we brought out things for people to do. I even managed to persuade someone to find something else to have on the telly except CBeebies!

After lunch I sat with a gentleman who I shall call 'Mr M.' and we talked about the motorbikes he’d owned over the years. I was about to start the dinnertime medication round and had begun to ask him if he needed any of his PRN medication when suddenly, he lurched towards me and started to scream at the top of his voice – now I wasn’t expecting that!

One of the carers dashed over in panic mode. Thankfully he didn’t apply the choke-hold I feared, but quite competently assisted Mr M. back to his chair, then shouted a colleague to get his meds.

Mr M. was still shouting and screaming at this point, when the carer looked to me with exasperation on his face and told me in no uncertain terms that "Mr M. is a pain in the arse. He’s like this all the time" and apparently they don’t prescribe him enough Diazepam. It is apparently only 'as needed' and it isn’t enough to keep him calm.

I bit my lip rather than deliver a lecture on what a chemical cosh (or even basic respect) is and excused myself to check Mr M.’s MARS sheet. If he was on any medication for his behaviour he would probably be due a dose. As I looked through his sheet a penny dropped, I noticed that, apart from PRN meds to calm his behaviour, he was also written down for 'as needed' pain relief, which had been consistently marked down as 'not needed' - and therefore not given - for the entire month!

It was then I suspected his behaviour wasn’t behavioural at all.

I went back to Mr M. with the carer closely by my side and tried to talk to him. He continued to shout and scream but his face was screwed up and it was difficult to tell what he did or didn’t want. I asked him openly if he was in any pain and I got the slightest of nods in return. It was only small, but it was definitely a nod.

There was no way I was going to give him meds to calm him down if his real problem was pain! So with the help of my carer bodyguard, Mr. M. allowed me to take him to his room and took his painkillers with no problem. Twenty minutes later he was sleeping like a baby on his bed, me stroking his brow.

At the end of the shift, one of the carers approached me and said "Oi Lawrence! We’ve had a lovely day…will you come back again?"

How’s that for a compliment?! Lesson for today? Don’t judge a book by its cover.

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