what can you say - page 3

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... Read More

  1. by   deespoohbear
    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...
  2. by   veetach
    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?
  3. by   veetach
    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.
  4. by   nurseleigh
    quote:
    --------------------------------------------------------------------------------
    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
    --------------------------------------------------------------------------------

    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 What are these nurses doing all night?

    Leigh
  5. by   New CCU RN
    ooops submitted twice...:chuckle
    Last edit by New CCU RN on Mar 6, '03
  6. by   New CCU RN
    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...
    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.
  7. by   Chiaramonte
    "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!!!
  8. by   JBudd
    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.
  9. by   nursedawn67
    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.
  10. by   ERNurse752
    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.
  11. by   AngelGirl
    Greer128
    Thanks for the insight, both in your comments and in the lines you have listed below your post. Very provocative.
    :angel2:
  12. by   Hellllllo Nurse
    Originally posted by RainbowSkye
    .......Do any of you nurses who work in long term care have any suggestions?

    I used to work LTC, did it for years. But I gave up. I will never go back. As the only nurse for 65 pts (9 tube feeders, two trachs w/ MRSA, all the rest demented, frequent falls, total care, etc). I had 3 aides usually, sometimes 2.

    Many of the charts do not even contain the residents' code statuses, or even their allergies.
    Many times, I've called res' "next of kin" or "responsible party" as listed on face sheets to find that the phone #s are disconnected, or are incorrect.
    Many charts do not have an H&P.

    I once had pt who had a clogged G-tube. I removed it and inserted a foley, it worked fine. However, I was written up. I was told this was against policy, and that I should have sent the pt to the ER.

    As for FOS pts- Often CNAs will lie, and falsey document, saying a res had been having daily BMs, when they have not.
    Because if I give a laxative, Fleets or whatever, the pt will then really be having BMs, and the CNA might actually have to be involved in cleaning it up. So, they tell me the pt is not constipated. Some elderly pts always have hyoactive BS and distended abds. That's usual for them. You may not feel any stool when you check for impaction, either.

    Some CNAs also do not want to be bothered with actually taking V/S. So, they just write in fake ones.
    Also, many res are so combative that it is nearly impossible to get a decent assessment on them. These factors combined with the huge number of pts LTC nurses have to take care of, and you can see how problems w/ some pts are often overlooked until they are rather far along.

    I've had a few pts fall and break hips. Restraints (chemical and physical) are not permitted in most nursing homes. Adm feels that the nurse w/ 65 or so pts should be able to keep close enough tabs on all of them to prevent any falls/injuries.

    Yes, I've sent pts w/ hip fx to the ER. Even though I knew they were too old and frail for a surgical repair, I will not be able to get any pain med orders for the pt unless I have proof in the form of X-rays and documentation (from the ER) that the hip is really fx.
    I will also not be able to prevent adm from ordering the pt up and dressed in their w/c by 4am (w/ all the other poor souls) unless I have proof of the fx.

    Adm in LTC does not recognize nursing judgment. If you try to keep a pt in bed because they are ill or injured, adm sees it as you trying to get out of doing the work of getting the pt up and dressed.

    I have had pts returned from hospitals (many times) with bed sores that they did not have when we sent them out. I've also had an ER D/C a res back to me at 2am, w/ a temp of 102. This pt had hx of sz disorder and craniotomy.


    Even though I worked at one LTC for almost 3 years, I was unfamiliar w/ the baselines for many of my pts. Why?

    Because when you have such overwhelming numbers of people to care for, there some that always have something going on and take all your time. These especially needy and demanding ones prevent you from ever getting to know much about some of the other residents.

    I worked at one LTC where phone service was cut off as someone had "forgotten" to pay the bill. One of the CNAs lent me her cell phone so I could call 911 and call the ER to give report.

    Most LTC "medical directors" are a joke. Some have been the "provider" for years to residents that they've never even laid eyes on. They just come in, read the nurses' notes, write a progress note of their own, and leave.

    As for pt "dumps", often hospital attendings will D/C LTC pts from the hospital back to the nursing home on Fri afternoons, even if the pt is still acutely ill. This is because they will have fewer pts to round on over the weekend if all their nursing home pts are D/C.

    I have worked in a hospital, in med/surg. It was an awful hospital, and working conditions weren't much better there.


    My closest friend has been an RN for 25 years. Mostly in hospice and psych. She recently quit a job in LTC. She was the only nurse for 120 residents on nocs. She had 3 CNAs and one med aide.
    I worked with her in inpt hospice, and I know she is a fabulous nurse. However, she told me the LTC position made her feel "so inadequate and incompetent" because she struggled and struggled, but could not possibly provide good care for her 120 pts.



    I really enjoy elderly people, but I couldn't do it anymore. Trying to provide good nursing care in a nursing home is like trying to bail out a lake with a teaspoon.

    Leaving LTC really lifted an unbearable burdon off of my shoulders.
    Last edit by Hellllllo Nurse on Mar 15, '03
  13. by   RNCENCCRNNREMTP
    My favorite...

    Nursing home sends in a lady for evaluation after a fall.

    Has a knee prosthesis.

    Acutely has a distal femur fracture just above the prosthesis.

    I call nursing home to let them know patient is being admitted and tell the nurse...

    "She broke her femur just above her knee prosthesis"

    Her response....

    "OK, she broke her femur below her knee!"


    ????????

    "Noooooooooooooooo, the femur is that big bone ABOVE the knee"

    One of medic friends said it best..

    "When I get old and my family puts me in a nursinghome, every morning after breakfast, bath and new/clean clothes, I am going to S**T my pants!"

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