The Real Nurse Jackie: Keeping it real

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The Real Nurse Jackie
The Real Nurse Jackie
EDITOR'S NOTE: “The Real Nurse Jackie” is a new blog written by Jacqueline Vance, RNC, CDONA/LTC — a real-life long-term care nurse who also is the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. Her blog is updated weekly at

Let me introduce myself. My name is Jackie and I am (proudly) a long-term care nurse.

Like the fictional Showtime “Nurse Jackie,” I do have a bad back, ironically have two brunette daughters, and will get in anyone's face — doctor, family member, surveyor, government official  (though politely and without the four-letter words) — who interferes with the health and wellness of our frail elders.

Like my fictional counterpart, I'm passionate about what I do. But that's where the similarity ends. Yup, no drug addiction — just a major coffee addiction — and no extramarital shenanigans.

Now the editors at McKnight's are brave enough to let me start a blog. It might at times be slightly irreverent, thought-provoking and challenging, and it might cause you to become introspective. Throughout, I promise you one thing: I'll keep it real.

So let's start out with a bang. Doesn't it just frustrate the heck out of you trying to balance legal and survey? You know, fear of survey penalty versus litigation. For example, we have to allow our residents the opportunity for sexual expression. Now, I will admit that I had to get used to walking past a sexually active resident's room and hear someone yell, “Who's your granddaddy!”

But that aside, here's the dilemma: So by regulation, we have to ensure that two consenting adults can have a private tryst. But what kind of beds do most of us have in the typical nursing facility? Hospital beds.

So you think, “Oh my gosh, if they fall out of bed and break a hip, I'm going to get sued!” Then you think, “OK, I'll just put up the bed rails. But wait, that's a restraint without medical necessity. I'll get a deficiency!”

I want to hear from you. Without disclosing the name of your facility, share a dilemma you face in this balance or share the most hypocritical deficiency you ever received and let's get this conversation going.


One of the things about working in long-term care is that it's both a blessing and a curse — knowing about aging. For example, it's not a good thing when you aren't prepared for it, right?

I remember clearly (it's actually indelibly imprinted on my brain for all eternity) the time I was not prepared for the changes aging brings. I was 18 years old, in nursing school and it was my first semester break. My father had gotten me a job at “his” hospital as a nursing assistant. So it was on my FIRST day, that I was asked to go clean Mr. Johnson who had a “BM accident.”

Now I thought I was savvy as a first-year nursing student — even though I had never actually taken care of a real human being before! After all, I had been around “medical” people since childhood; I had seen my first autopsy already so I thought I could handle anything. But when you are 18 years old and the first naked man you see is 85 years old … yeah, all I can say is I took anatomy and physiology and nothing was where it was supposed to be!

Put it this way: My dad couldn't have purchased a more effective birth control! (And seeing how he was the one who had gotten me the job, do you think …? )

But see, now that we study aging, we know what happens to the body as we age. We know our skin has a secret will to hit the ground before we do. So while it's scary knowing this will happen, it also completely skews our outlook on life.

For example, I can't look at a tattoo and not wonder what it will morph into. That cute little butterfly on the hip? At 75, that sucker's a pterodactyl!

That rosebud that's strategically placed? Um, long stem and NO longer attractive! I actually think we should have a new reality game show. Get a bunch of aging bikers together and let's play “Name That Tattoo.”  That might be fun.

So, OK, if you really have to get a tattoo, go with the evidence, go with what we've learned, right? If you need a tattoo in that “strategic spot,” how about a dachshund? That way, when it elongates, it looks normal. Cool!
Don't you wish you could pass on this wisdom to Generation Y? So many are not only tattooed from head to toe but also multiply pierced. Not one or two piercings in an ear but so many that the ear looks like a spiral notebook.

Ahhh, but we know something important, don't we? We know that as you age, the ear continues to grow. Yup, there's going to be a whole generation of people who will whistle when a strong wind goes by! I can hear it now: screechy little voices yelling, “What the heck is that noise?!”

So when the “job” starts getting to you, just stop for a minute and smile. This could be 40 years in the future and you could be looking at a morphed tramp stamp that looks like a gargoyle! Makes your day not seem too bad, eh?

Keeping it real,
Nurse Jackie

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