The Life of a Night Nurse: A Look Inside the Quiet World of Elderly Care

2023-11-12 10:50:00

“At night, there is not all the excitement that one can experience during the day, such as meals or family visits. The residents are more peaceful, there is no noise. It’s another world, a different rhythm. And that’s what suits me,” he confides following putting on his nurse’s outfit.

After checking that the exterior doors of the building are securely closed – “That’s my first job”, he slips -, the just sixty-year-old joins his colleagues for the followingnoon. Before the latter (there are only women in the team, apart from Pierre) leave the home, they report to him what happened during the day. One of the team members reviews the binder containing the files for each resident and lists any special points of attention. This evening, nothing special to report. “We will just have to open to Madame Leblanc (the names of the residents have been changed), who has gone out with her family and will return around 9:30 p.m.,” indicates the nurse before closing the report.

At each shift, the nurses who finish their work report what happened to the next ones. ©Ad.R.

The clock reads 9:14 p.m. The daytime nurses and caregivers have left and Pierre now finds himself alone, until 7 a.m. the next morning. Since the end of 2015, there has only been one night nurse to take care of the 55 residents of “his” rest home. The main reason given: there is not enough work for two caregivers during the night. “But it is also a financial reason, because a night nurse costs more,” underlines Pierre, specifying that it is from 60 residents that it is obligatory to have a second person to work at night.

“If I’m here at the home, it’s also to have company”

Pierre begins his “day” of work by going to say goodnight to the residents who are not yet asleep, and to take a look in the rooms of those who are already asleep. He adapts his tour of the rooms according to the residents: “I know that some will call me at the beginning of the night, so I will check their room now and I will come back later”.

“Cuckoo ! Are you okay?” he says as he opens the first door. He talks a little with the patient, then helps her into bed, wishes her good night and explains that he will come back later. He then goes to another resident’s house. “I was waiting for you to go to sleep,” this lady confided to him with a big smile. “We’re happy to see you in the evening, Pierre. If I’m here, it’s also to have company,” emphasizes another resident, quite talkative, seated in her armchair in front of the TV on. The conversation lasts regarding ten minutes, then the nurse leaves the room to continue his tour.

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Saying goodnight to the residents is also very important to Pierre. These are the only people he will see during his work, and the residents are asking for this little moment of exchange. “If I don’t come and see them in the evening when I arrive, I will never get to know them,” explains the nurse, who almost never works during the day, only helping out when there is a shortage of staff.

During the night, Pierre makes three rounds of the rooms. ©Ad.R.It’s bedtime for the residents of the home. ©Ad.R.

For those who are already asleep, Pierre turns off the television and/or the lights, or puts the bed sheets back in place, before slipping away quietly. “Right now, there are fewer people to chat with compared to two or three months ago. Some are in hospital, others have not returned… It’s the cycle of life”.

In the corridors that night, apart from the noise of the television from a room left open and the coughing of a resident, everything is calm. In the quiet, a resident suddenly pokes his head out of his room. “Is everything okay, Mr. Dupuis?” Pierre asks him. He says yes, then immediately turns around. Some doors are closed, others open or ajar. Among disoriented residents, the door often remains open, “so we can hear them, if ever”.

At two residents’ homes, Pierre locks the door following passing through. One because he already escaped in the middle of the day and was found two kilometers from the rest home. The other resident is afraid of intrusions since another resident caused chaos in the neighboring rooms. “There were stories of thefts between residents a few months ago. We had never had that,” explains the nurse, stopping near a trolley to complete the care plan and note what he did with the residents (putting them to bed, changing protection, etc.).

At night, calm reigns in the corridors of the rest home. Unlike during the day, when four caregivers go from room to room and help residents with their daily activities. ©Ad.R.

Working alone means learning to make choices in case of problems

Between 9 p.m. and 7 a.m., the Theutois makes three rounds with residents. He moves through the corridors, from the 1st to the 3rd floor, with two telephones on him: one allowing calls from outside, and the other which is connected to the doorbells which are in all the rooms. Besides, a patient just called. The lady would like medicine to help her fall asleep without having nightmares. Another rings a little later so that Pierre can help him get to the toilet. That night, he will have to respond to around twenty requests in total. Including those of a resident who constantly keeps her finger on the call button…

“The hardest thing regarding finding yourself alone at night is not the physical side of the work, but the fact of sometimes being overwhelmed or overloaded and not being able to hand over to a colleague,” believes Pierre. For the moment, the night he is spending is fortunately calm. But two days earlier, her colleague ran around because three residents were disturbing other people’s nights and needed her at the same time. In this type of situation, you then have to make choices: “If two big cases arise simultaneously, you have to be able to establish priorities. And the other residents will have to wait, because we can’t do two things at the same time.” But several people can be called in the event of a problem, whether it is the concierge, the head nurse, the director of the home or even the president of the CPAS.

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On weekends, the night nurse is also responsible for preparing the residents’ medications for the entire week to come. For more than two years, treatments have been prepared, using a computer system, by a pharmaceutical group which delivers precise doses of medication for each patient once a week. Each corresponds to a roll of small sachets which contain the pills. That night, for several hours, Pierre methodically distributed the medications into the seven pill boxes (one per day) of each resident, their treatment sheets before their eyes. If the machine rarely makes errors, it is important to check that everything is correct. And one of her colleagues will check everything once more on Monday. “The fact that everything is automated is economical and practical, because patients only pay for what they consume. But that doesn’t change the quantity of medicines that patients ingest…” slips the caregiver, sometimes impressed by the number of pills prescribed.

Each tray on the shelf contains a patient’s seven pill boxes, which the night nurse fills on weekends with all the medications needed for the week. ©Ad.R.The pill boxes of the week in preparation ©Ad.R.

After preparing the medications – interrupted by several calls from residents to go to the toilet or to be changed – Pierre proceeds to his second tour of the rooms. It’s around 5:30 a.m. and a resident already wants to get up. “Try to get some more sleep,” he encourages. Thirty minutes later, light filters under the door of the room of a resident with whom he had chatted a little the day before. “I’m going to go wash,” says this early riser, who manages quite easily on her own.

Pierre finds it important to take the time to chat with residents who are awake during his work time. ©Ad.R.

“Am I going to recover from my great old age?”

Screams then disturb the calm of dawn. A resident calls her mother. “Who are you?” asks the lady when Pierre enters her room. He reminds her who he is and that seems to calm her down. But only for a minute, because she repeats her question immediately. Pierre reassures her once more, then helps her get ready for the day. “Can we heal from all this? About my great old age?”, suddenly worries the resident, who arrived in the rest home just following the Covid. “Oh but old age is not an illness you know, Madame Joly. We’re not going to cure you of an illness that you don’t have, are we?” he told her tenderly, which made the resident giggle. He then places her in her armchair, near the window so that she can see outside when the sun is up. But it saddens him: “We go crazy staying like that all day…”

“There was a time when we only came at 6:30 a.m. to wash her back, otherwise Madame Joly always got up very early and washed herself alone. She always needed to be reassured, but was not disoriented when she arrived here,” says Pierre as he leaves the room, shocked by the dazzling dementia that has affected this lady.

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It is now time to join his four colleagues from the morning, who are arriving slowly. It’s his turn to report this time. “Madame Joly is nothing more than a shadow of herself,” he says with a touch of sadness and resignation to the rest of the team, who acquiesce. “His condition has really deteriorated in recent months,” reacts a young caregiver. They go through the files concerning the residents together, but there is not much to report this morning.

The baton has been passed, Pierre leaves the home around 7:15 a.m., while his colleagues are preparing to start washing the first residents. The rhythm has just changed, life is resuming in the corridors of the Theutois home.

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