what can you say

Specialties Emergency

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Howdy yall

from deep in the heat of texas

I will never understand nursing homes or nursing home nurses. After another lovely weekend with sick people, trauma of all sorts. psych patients and the usual ER stuff. At 0200 hrs a nursing home nurse sends you a patient who fell several days ago.they got an xray, and early saturday morning they send that pt to you with a fractured hip, that no ortho doc is gonna touch as the patient is completely bed ridden, so after examining the pt and doing all the usual workup, you send her back to the nursing home with pain meds. And then the nursing home nurse calls and demands to know why you havent rushed the patient to the OR.

Then another nursing home sends you in a CPR in progress, of an elderly patient with marked lividity and rigor. After you pronounce and notify their family and the family yells at you because they had a advanced directive prohibiting resuscitation. Of course that was on file at a the nsg home, we have no copy and the paramedics werent made aware of it.. Then the family yells at you even more because of you telling them they need to come in and do some of the post mortem paperwork. I dont know what to think of this.

Then another nursing home calls EMS to transport a patient who is seizing to you. You get the patient you take a rectal temp, and the temp exceeds what the IVAC thermometer will measure. No wonder she is seizing. The patient does not make it. You call the nursing home and ask what has been happening with the patient, they tell you shes been ill for a couple of days. You ask when she was last given tylenol, they respond yesterday morning. Then they say we didnt want to mask any signs or symptoms that might be important to you..... How can you tactfully respond to them......

Then there is the one who pulled or had pulled their PEG tube out and they send him over to you. Thats not a problem you slip in a foley and secure it and send them back, as the ER docs arent and the GI docs arent going to replace a PEG in the middle of the night. You send the patient back and again the nursing home nurse calls and yells at you again for not putting that PEG tube in that they wanted.

I dont know about yall but I tend to cringe when the secretary calls and says there is a nursing home that wants to give us a patient report... I know there are good nursing homes and good nursing home nurse out there somewhere. but I havent been running across any of late while working...

Sorry yall. It aint like me to vent to often, but when I do.

meanwhile

doo wah ditty

Specializes in ED staff.

The grossest is when the NH sends in a patient who codes and you pop their dentures out before they get tubed and you can tell they haven't been cleaned in several months. One of the only things that makes me wanna vomick.

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We got a male patient the other day from a nursing home in the ER. The NH reported the guy had peed after they anchored a foley the day before. Bring the guy in, the ER nurse deflates the bulb, advances the foley, and SHAZAM! urine. Go figure? Called them back and said guess what? You are getting this 90 y/o full of cancer, confused, full code back......:D

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Originally posted by berry

my fav is to ask the nurse calling you report on a pt the are sending over for resp distress and you ask for v/s you get the long pause then a hold ...........wtf i always ask 9/10 times they dont know course no big deal as you will get an ems report in route and actually find out what is going on with the pt. My biggest pet peeve is pt in arrest situations with no lines damn NH have RNs i am sure of it how can you send a pt with no line i know you had time between finding them and ems arriving, and howbout switching form 2lnc to a nrb for pts with sats in the 70's

In a lot of nursing homes the nurses are not allowed to put in lines....your facility has to be a skilled nursing facility....plus a lot of the nurses in NH do not know how to start IV's....so you can't really get upset with them...the O2 is a different story...they are allowed to put O2 on them....and advanced it as needed...:rolleyes:

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Specializes in Emergency Room/corrections.

Kayzee, I would just like to say that you are right. There ARE good LTC facilities out there, thank goodness you guys are there. But I do think it is a universal problem that a lot of them are not so good. We have our share of bad ones too.

My husband is a paramedic, he says they have a problem with being called to the NH and walking in and there is not a sign of a staff member. They know what room the pt is in, and go to take care of the pt. and sometimes they have to send someone from the EMS crew to find a staff member! Now hmmm If I had just called 911 for a patient wouldnt I want to be at that pts bedside when EMS arrived??? maybe I have been an ER nurse too long?

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Specializes in Emergency Room/corrections.

deespoohbear, just day before yesterday, we had a pt in resp distress come in from a NH. his sats were in the high 60's and they had put O2 on at 2 liters per NC??????

the guy pinked up when he got some O2.

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quote:

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Originally posted by berry

my fav is to ask the nurse calling you report on a pt the are sending over for resp distress and you ask for v/s you get the long pause then a hold ...........wtf i always ask 9/10 times they dont know course no big deal as you will get an ems report in route and actually find out what is going on with the pt. My biggest pet peeve is pt in arrest situations with no lines damn NH have RNs i am sure of it how can you send a pt with no line i know you had time between finding them and ems arriving, and howbout switching form 2lnc to a nrb for pts with sats in the 70's

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Also, the NH I worked(past tense) in, at night we usually didn't have an RN on staff and the one that was there occasionally wouldn't ever even try to start an IV because "she hasn't done that in years." Direct quote from her.

I just can't believe the stuff you guys are saying :eek: What are these nurses doing all night?

Leigh

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ooops submitted twice...:chuckle

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Originally posted by deespoohbear

In a lot of nursing homes the nurses are not allowed to put in lines....your facility has to be a skilled nursing facility....plus a lot of the nurses in NH do not know how to start IV's....so you can't really get upset with them...the O2 is a different story...they are allowed to put O2 on them....and advanced it as needed...:rolleyes:

I understand the facility needing to be skilled in order to maintain IVs and IV gtts...makes sense.... However, in an emergency with patients that are full codes, how can the facility justify not having at least one nurse on staff that is trained to at least start the IV. That is basic nursing care. :confused:

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"The grossest is when the NH sends in a patient who codes and you pop their dentures out before they get tubed and you can tell they haven't been cleaned in several months. One of the only things that makes me wanna vomick."

Yep, this also brings me to my knees begging for mercy!!!

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Specializes in Trauma, Teaching.

I worked LTC long time ago, when I wanted a job for just a few months. The center station was not in use because the roof was falling in, and the whole place had been condemed by the state. It was bought out by a national chain and being refurbished, but WOW!

I went in one morning after several days off, and was told this little old guy, normally self care and ambulatory had been c/o CP for several days. I asked what his VS were, but it wasn't time for his once a month vitals so noone had bothered. I asked what his chest sounded like, but noone had listened for breath sounds or irregularities. Very basic assessment showed no BS LLL, dull to percussion, the whole bit. Textbook pnuemonia, called his doctor who actually laughed at me, okayed a CXR at the VA, and called back to apologise because the guy really did have pneumonia! Evidently he was so used to noone knowing anything from there he couldn't believe I'd know what to do. ARGH!

Same place, woman c/o ear pain for several days, I asked if anyone had used that brand new otoscope the national chain had bought for us, and was told noone knew how. Irrigated out a huge wax impaction, her husband came up and said I was the only one who ever listened to them. Broke my heart.

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Specializes in Geriatrics, LTC.

Sound like you all have dealt with some really crummy nursing homes...where I work we call report to the ER before the resident even leaves the floor. Residents are not sent to ER unless an order from their family dr is received (extreme emergency they are sent and then Doc called). O2 is put on them if called for...unfortunately I cannot put an IV in, and there isn't always an RN in the building at night. No one gets cpr unless their advance directives state that is their wishes. And then as we are doing the CPR they are taken next door to ER (we are in the same building as a small hosp). And when a resident is to return to the NH from ER a staff member or two are sent ASAP which means within minutes from ER calling us. But unfortunately there are some REALLY REALLY terrible NH out there.

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A couple nights ago around 0500, we got a call from the ECF across the street. It seems that about 24 hours prior, this pt had a Hgb of 6.2, which they were now sending her to the ED for...

We drew a CBC, her Hgb was 12, so we sent her back.

:rolleyes:

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