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.
doo wah ditty
Sep 17, '02
Wow! I would hate that too. This is a great place to vent and to get encouragement.
I am an RN in a nursing home. We do send many patients to the Er with full lists of all meds, history, etc. It sounds like you have to deal with some pretty lame people. I know you did not slam all nursing homes. I just wanted you to know that there are decent homes that people are proud to be a part of. We have a 2 year waiting list for our home. Why would the last time they gave Tylenol be a day before when a patient is running a temp? How do you keep a civil tongue?
Sep 17, '02
Teeituptom: 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...
Me: I get that same cringe. The best part is when you get to make the call to tell the NH that the beloved Mr. / Mrs. ____ is comin' back to 'em. Usually there is a pause as they too experience "the cringe" by knowing their day/night just took a turn for the worse.
Sep 17, '02
Tom....boy oh boy can l ever hear you loud and clear.....ya know what....l am kind of burned out and l went on an interview for a supervisor pos at an ECF last week...all days, no wknds....coming from an ER perspective l asked a lot of questions....consider this; ECF's staff w/ a lot of agency and PRNer's.....and..float the supervisor when needed....think of all these nurses not familiar w/ the pt's...and then l ask, "how do you know the residents code status?''....well the state regs are more concerned about the pt's privacy than they are about the whether or not the pt survives.....so how do they chk code status????...you go to the nurses station and chk the chart!...Nurses are there to pass meds and do tx....heaven forbid there is time to monitor the pt's who need anything extra.......Tom, l really do feel your pain because yes the NH's do dump a lot of crap on us.....and l complain too...but this interview reminded me of why l don't do ECF.....
God bless those of you that do and are dedicated..........LR
Sep 17, '02
Same everywhere Tom. I get the same cringe. How about change in mental status in a normally confused pt. Minimum information on transfer sheet. You have to stop and call and the nurse who sent the pt. has never taken care of them before and doesn't know their norm. Geeez, how do they know there is a change???
Personal Care homes are great for sending people with non urgent complaints by ambulance and then they have no way home when they're are discharged.
Again I will also state this is not all nursing homes or PCHs, just venting frustration. I have much respect for those who work in NH's and know they have many frustrations too.
Sep 18, '02
Teeituptom: Yours is a common complaint, and as a former med-surg nurse I remember "the cringe" well and often did it myself(oh great, another confused nursing-home resident with FOS syndrome because they've let him go 10 days without a BM!). On the other side, I can tell you that we who work in LTC have one HELL of a job to do, and we really hate being looked down on by nurses in more "glamorous" occupations. Any LTC nurse worth her (his) salt knows that you phone in report to the ER right after you've called 911, send current face sheet, code status, and med sheets with the patient.......not to mention a recent set of vitals.......that's just common sense. Yes, there are nurses who lack that essential ingredient, but this is not unique to nursing facilities. Please don't tar all of us with the same brush!!
Sep 18, '02
I've been in the ER for a year and a half--and can honestly say I've NEVER received report from an LTC nurse. We get report from the medics and that's it. We do for the most part get very adequate paperwork on the pt from the facility as far as Hx, meds, etc.; but have to rely secondhand on what the medic says the nurse told them upon arrival about precipitating events, status for the past few days. Usually this system works out okay, but can be frustrating when you're getting an unresponsive pt and don't have a good baseline knowledge of the pt.
Sep 19, '02
I remember walking rounds with the nurse and the doctor at a LTC facility I did clinicals at for school. I had worked there previously for a years as a CNA. The doctor wanted a psych consult on a lady who was acting the same way she did 5 years previous when I worked there. She had many psych consults in her time. Neither the nurse or the doctor knew this was how she had been for years. I was lucky that the nurse was nice to me and I told her that there had been no change in her behavior in 5 years. They cancelled the psych consult. But it makes you wonder. The DON used to come around and hand out their daily extra useless paparwork every day for the nurses to do on their down time. Made me sad that these nurses never got a chance to really get to know thier patients, but the DON was obsessed about this extra stuff they were supposed to do. They ran constantly and barely got the meds passed and treatments done. God forbid someone should fall or get sick.
Not making any excuses for anyone here because I have had these really frustrating patients come in from the same LTC facility without report and such, but thought it was interesting to see the other side of issue while in school.
Sep 19, '02
I'm sorry that's been your experience, neneRN. Sounds to me like the LTC nurses in your area need some education about transferring pts to the hospital. Of course, many LTC nurses have never worked in a hospital and don't really understand what's needed, but that's no excuse for failing to call ahead and let the ER staff know what they're in for.
Sep 30, '02
ltc/nh in my area are famous for the "dump at about 8-9pm "
with complaints that have been going on for weeks then when we call to have them pick the pt up they claim to have nobody to come ( wheel chair transport is only days) so i have taken to calling the nursing home adminstrators at home in the middle of the night i usally get rapid results. i dont mind the pts.so much as the staff and the shouldnt be called "nursing " homes as very few even use RNs
Oct 1, '02
I dislike the dumpjobs on Fri evening when admin has gone home and whoever is working decides someone has a "change in mental status" sent by ambulance to the ER, but they have been crotchety and confused for years. So a little Ativan and Haldol is given, pt falls asleep, ready to go back, and they refuse to take him/her. It is a dump- so now hospital gets to be a boarding home for someone with a placement problem. What happened to EMTALA there?
Oct 1, '02
what i hate, is when the ltcf sends the patient who fell. needs sutures, that is fine and dandy but normally we need to send them back BUT ALAS, no phone number, address, or name of the ltcf on the face sheet. just the pts information, diagnosis, religion, core status....
i then have to look at the trip sheet, (if i can find it, but that is another whole ball of wax) and find all i have is the address, still no name of the facility. ugh... then a call to the dispatch of said ambulance company to find out WHERE the heck this person came from.
what should have taken 10 mins to do. call ambulance to take pt back, then call home to give report, and aftercare instructions. takes an hour or more to do.
THAT is the most frustating thing. i never minded getting nh patients. many times they are in and out. just the hurry up and wait for lab/xr results. then transport. it is when i have to spend stupid amounts of time trying to figure out where they came from, and who to call.
Oct 1, '02
Tom, I felt the same cringe when I worked ER, and recieved these patients with urine soaked sheets that had dried and been resoaked, and peas and corn under their breasts. Yeeeuuucchh!
On the other hand, I was always overjoyed to call report BACK to the ECF. Several times I was greeted with, "but I was told they would be admitted!" Turns out the nurse that sent them to the ER told that to the oncoming shift, not the Dr.! We do have one ECF in our area that is fabulous, and like Shygirl's has a 2 year waiting list. A person could die, waiting to get decent care!
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