what can you say - page 4

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   eldernurse
    I hate it when they send patients to the ED with change in mental status and we have to ask "How could you tell?" But one of the latest reasons to be admitted to our ED is "inability to ambulate!" Just because a person needs to be placed in a nursing home does not mean they need to get there via the hospital.
    We house many patients who really need to be admitted because our hospital is clogged up with patients waiting for placement. Something needs to be done.
  2. by   flashpoint
    How do you all handle after hours transports BACK to the nursing homes? Here if a patient comes to the ER via ambulance "after horus," one of out NHs expects the ambulance to take them back. Had a gentleman a few weeks ago that the NH called 911 for because he fell, NH thought he broke his hip, so...we show up and transport him to the hospital. We got him settled in his room, gave report to the RN, and sat down to do our run report. I looked up and saw our patient walking down the hall toward the snack machines. We went back to quarters and the hospital did a full workup on the paitent. A couple hours later, we got the call to transport him back. Our EMS Captain refused to do the transport becasue there was no medical necessity and there were other means of trasnport available. NH staff threw a fit because their tranport people had to get up at 0600 to come get him. It just seems like a no win situation to me...yes we are available to do the transports, but why should the NH resident pay $400 for a ride across town when they have no problem sitting in a car?
  3. by   AngelGirl
    eldernuse:

    I think that the idea of a family member placing aloved one in a nursing home is still a hot button for many families.

    To have the patient SEEN IN THE ER first seems to warrant more of a need for the loved one to "be placed," as far as the family is concerned.

    It's as though they think "Sissy did ALL she could with Uncle Tody, but when he had to GO TO THE HOSPITAL!! then, it was time to put him in a "home."

    Sometimes the heart won't accept what the mind already knows.
  4. by   TazziRN
    Our local NH called and told me they were sending me a woman with SOB and low sats in the 60's.

    Me: "IS ANYBODY BAGGING HER????"

    NH: Oh yes, a paramedic is at the bedside now.

    Me: (relieved) Oh, okay.

    Pt gets here and the medic is so mad his ears are steaming. They got to the pts room at the NH and found her with no RN in sight, two CNA's there cleaning the pt up after incontinence, the pt was very altered and cyanotic. That's when the medic took charge and started bagging the pt! I was also told in report that the lung sounds were clear. The medic found her to be full of fluid (we eventually pulled off nearly 1 liter after Lasix and the pt perked right up). We have one board and care home in the area that is excellent; the owner usually brings her residents to us herself unless an ambulance is needed, and stays until a disposition is decided. If for some reason she or one of her relatives can't stay, they leave us a number at which they can be reached. This place is definitely the exception to the rule.
  5. by   ERNurse752
    Originally posted by TazziRN
    Our local NH called and told me they were sending me a woman with SOB and low sats in the 60's.

    Me: "IS ANYBODY BAGGING HER????"

    NH: Oh yes, a paramedic is at the bedside now.

    Me: (relieved) Oh, okay.

    Pt gets here and the medic is so mad his ears are steaming. They got to the pts room at the NH and found her with no RN in sight, two CNA's there cleaning the pt up after incontinence, the pt was very altered and cyanotic. That's when the medic took charge and started bagging the pt! I was also told in report that the lung sounds were clear. The medic found her to be full of fluid (we eventually pulled off nearly 1 liter after Lasix and the pt perked right up). We have one board and care home in the area that is excellent; the owner usually brings her residents to us herself unless an ambulance is needed, and stays until a disposition is decided. If for some reason she or one of her relatives can't stay, they leave us a number at which they can be reached. This place is definitely the exception to the rule.
    That sounds like what tends to happen at the ECF's near me...there is a critical pt and no nurse at the bedside...or a pt with sats in the 70's, and they've been placed on 2 L per N/C.

  6. by   teeituptom
    Arent you glad nursing homes never change, just comsider them job security due to their ineptitude.
    Had a patient brought in from NH the other night. Nurse at nursing home called 911 and started cpr on a patient that she couldnt feel a pulse on. All the while the pt was yelling at her to stop. Paramedics had to pull her off physically.
    Yes the pt had several broken ribs.
  7. by   athomas91
    :roll :chuckle
    i guess NH are the same everywhere!!!
    ours will send us a DNR because "they won't eat" - what do they want us to do - shove food down their throat?!?!
  8. by   Medic946RN
    Originally posted by TazziRN
    Our local NH called and told me they were sending me a woman with SOB and low sats in the 60's.

    Me: "IS ANYBODY BAGGING HER????"

    NH: Oh yes, a paramedic is at the bedside now..
    Been there, done that, got the tee shirt and baseball cap!

    One of the last runs I took before going to nursing school was at an ECF for the famous difficulty breathing call. On arrival the EMT crew was trying to bag a pt though her stoma, the nurse(and I use that term very lightly) was standing there with an aid and her hands on her hips.
    Me: What's going on?
    Nurse: Well she does this.
    Me: Define this as it applies here.
    Nurse: When she codes, she codes.
    Me: (to EMTs) Is she in arrest.
    EMTs: No she's just having trouble breathing, we can't bag her that well.
    Me: Attach the bag to her trach tube.
    EMTs: She doesn't have one.
    Me: No prob we'll make one outta 7.5ett. (A good medic can make anything out of a ET tube some o2 tubing and tape)

    I go to place the ett into her stoma and guess what, it won't go in past the cuff.
    I look at the nurse
    Me: Did you suction her?
    Nurse: We have the equipment
    She did. It suspiciously still had the dustcover on it.
    I whip out my suction, squirt a saline bullet down the stoma and suck out the biggest, nastiest mucus plug I have ever seen.

    The patient coughs, smiles and motions for me to lean over to her. I do and she kisses me on the cheek and whispers thank you.

    I hold her hand and say "C'mon sweetie, lets get you to the hospital before they kill you here." (I was a real smarta$$ in my younger medic days)

    On arrival to ED pt was sitting up and smiling, conversing well and had an 02 sat of 99 with 2lpm 02. The ER doc told me. "You fixed her, so go ahead and take her back, but unfortunately, the ECF's in that area wouldn't accept a patient back once they left by ambo until they were medically cleared by a doc. So she got to sit in hallway and the NH got rid of one those bothersome, labor intensive pts who might need to checked on more than once a day.

    (climbs off soap box)
    Thanks, I needed to get that one out.
  9. by   BRANDY LPN
    I do not work LTC anymore and never will again (if that were the only choice I had You would find me at the local diner serving cheeseburgers) Because like another poster mentioned you have about 50-60 patients you have to do meds and treatments and charting on ALL of these pts some of these pts receive 10-20 differnet meds at a time and they have to be crushed in applesauce ect. also you have to check CBGs on the diabetics. Put out fires all over the place ect. this does not give time to get to know the residents, or to do much nursing care. You have to relie on what the aides tell you and that is not always acurate, but you dont have the time to check yourself when you have that many pts. I dont beleive that this is a problem caused by nurses but rather admin. and the laws that allow this to continue, to the OP if you really want to see change please contact your representitves.


    On another note this issue cuts both ways (prob. because of all the unneeded transfers) I once sent a lol to the ER with sats in the 70s (with 02 via non rebreather) and with full report (including v/s) and got her back in like an hour with dx of sinus infection. (she was long time copd and full code) and two hours later had to call EMS back to get her in the middle of code she was on vent for two weeks and ended up coming back fine. This same day had 2 res fall and had to ship both for fx , plus continue with all the other duties I was still passing 6am meds at 12 when it was time to start next med pass and the RN supervisor would not come help me, she did eventually send someone else to do my treatments but that didnt really help with the fact that I was 6 hours behind on the dang meds. So before you judge too harshly try to put yourself in the shoes of the LTC nurses can YOU imagine being the only licensed personell to give all the nursing care to 50-60 pts? This is not intended as a flame just hopefully an eyeopener.
  10. by   ktwlpn
    i dont mind the pts.so much as the staff and the shouldnt be called "nursing " homes as very few even use RNs>>>>>I will not even respond to THIS remark here on this thread...........But-I will never understand how acute care facilities treat the elderly frail and demented...I have lost count of the number of my residents that have returned from the hospital with significant wt.loss(I am talking about the ones that were not NPO for some abdominal c/o) Pressure ulcers and diaper rashes galore and just plain smelly and dirty.....We know there are good and bad LTC's -also good and bad nurses and hospitals....I cannot understand why the elderly do not have a specailized unit in acute care as they have different needs then a middle aged or young adult...We have PEDS,NICU etc...why not units staffed with extra aides to deal with the non-skilled needs they may have-the self care deficits......I know what kind of info you need to care for a resident that is unable to speak for themselves and I send it and also call report.I also call the families and try to persuade them to meet their loved one at the ED-most can not be bothered....Other points I want to address....Often the staff docs make hours at odd times-it is not unusual to see a few roll in at 9 or 10 pm...that could be why you see an admission late at night that has been ill for days according to the paperwork--or the family initially wanted their loved one treated in the LTC and changed their mind....As for transportation-we contract with a private ambulance service for non-emergent cases-24/7.....As for increased confusion-many of us KNOW our residents well-just because someone had dementia does NOT mean that they can not convey distress in some way....It is easy to care for patients that can tell you where they hurt but for those that can't we are challenged to look for other clues....I work in a 250 bed facility -we have had 3 residents who developed pressure ulcers while in our facilty in the past 2 yrs......all 3 of them were very compromised to begin with (I am not excusing it-but 3 out of 250 in 2 yrs seems ok to me) We all know some lousy nurses and admittedly they are weeded out of acute care much faster then LTC...But please do not paint us all with the same brush-I have also had residents return from acute care clean with skin intact and looking good.......
  11. by   Rapheal
    We all have stories about the good and the bad. Let me add another stirrer to the the pot- NH family members.

    We had a NH admit, a pt with urosepsis. She had been bedridden for a long while and incontinent of liquid stool x 1 month. Her daughter was telling me that she is going to sue the NH because they do not know how to clean a woman properly- from front to back and that is why her mother kept getting UTI's. I explain to her that diarrhea on a bedridden patient will find it's way to the urethra even with frequent and proper cleaning. The NH had done stool cultures and no c-diff or parasites and ova. Also this patient had intact skin. The cause was still unclear. But this lady was insisting that the NH was at fault.

    Or what about when the family starts griping that the NH has made their 96 year old grandmother confused. "She was fine before she got there." Look in the H&P and see dx of dementia or alzheimers along with about 12 other medical dx's. Okay, sure.
  12. by   hogan4736
    I've been on both sides

    please see:

    http://allnurses.com/forums/showthre...879#post633879

    sean
  13. by   TheCommuter
    Quote from JE1RN
    i dont mind the pts.so much as the staff and the shouldnt be called "nursing " homes as very few even use RNs
    A person does not need the title of "RN" in order to provide competent nursing care. I know what is being implied, and it is disgusting. LPNs/LVNs are not merely "attendants" at nursing homes. I am employed at a nursing home, and I am certainly a nurse.

    Although this thread is old, I felt obligated to respond.

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