ER vs. LTC Facility staff

[nursedawn67]

What's up with some ER staff feeling that the nurses and staff in a nursing home are just a bunch of yahoos?!

Now don't get me wrong not all ER personnel treat LTC staff this way but I have experienced a major example of this.

I work 6p to 6a shift in a 120 bed facility that is attached to a small hospital. This particular evening I was taking care of a lady in her 60's, she was full of cancer, and activly dying. We knew it was a matter of hours for the poor lady, but to the families dismay she was a full code (the family had wanted to change this but she was her own person and just 3 days before was able to talk and state her wishes). Anyhow I had all my aides ready and aware of what to do when the time comes. The woman started to run a high temp and I decided to go ahead and give her a tylenol supp, as she was looking like she was uncomfortable. About 2 or 3 hours later, I went to check on her with this weird feeling she was gone, sure enough she had quit breathing as I walked into the room. My aide was out in the hall I yelled to him to get the crash cart and yell for help. I immediatly started CPR, and the rest of the staff came in and we transferred her to the gurney, one nurse got onto top to continue chest compressions, I manipulated the ambu bag, while 2 aides pushed the gurney to the hospital at top speed. When we arrive at ER, with the ER's full knowledge we are on our way, they look at me and say "why did you bring her here she looks like she has been gone for 10 years?" I told them this is my job, and I don't care how she looks I have to bring her here." So as their nurses hook up to EKG and do their procedures, the ER doctor is arguing with me. She says "well I'm not signing the death certificate!" I said " I don't care who signs it, I'm doing my job and following the residents wishes and following protocol". She then asks me "did you call the doctor?" I said, "um no I was a little busy doing CPR!" So finally the doctor chills out and gives me a break. I go to where they had been working on this lady, and there are 2 ER nurses there unhooking the machines as she was pronounced. By now I have relieved my staff and sent them back to the nursing home. One of the ER nurses looks at me and says, "so what happened?" I explain the events of the evening and how I gave her a tylenol supp, the ER nurse then says to me "well was she alive and breathing then?" I'm just standing there looking at her....and say "uh no I always give supp to dead people...Of course she was alive and breathing!" The nurses finally apologized for giving me a hard time, I never did hear from the doctor, but I understand my director of nursing gave them an earful.

[P_RN, ADN, RN]

EITHER YOUR A GOOD NURSE OR YOUR NOT, ITS NOT ABOUT WHERE YOU DECIDE TO DO IT.

You go girl!!!!!

P

[4XNURSE]

Originally posted by askater11

Regarding reports being called.

".....I have never once "copped" an attitude with a nurse."

Wow! I'd like to be able to say that. I'm all too human. I've "copped" a 'tude, on way too many occasions. Come to think of it, I wouldn't like to be able to say that. I think there are times when we need to throw a lot of 'tude. As has been previously mentioned here, there are good nurses and not so good nurses, and I think those who have gotten lazy, need to be stimulated with a good swift (verbal) kick in the rear. Unfortunately, in my experience I've seen more lazy nurses in LTC than any other area. If you are not one of those lazy or incompetent nurses, you shouldn't be offended. If you are on of them you need to take a clue and brush up.

Lest anyone misunderstand, I also think I will always have a lot to learn. You work with me, and see me leaving something out, call me on it. Give me h***. I need to be as good as I want any one else to be.

ken

[JillR]

I ditto what CEN said.

[askater11]

Ken~~

I'm neither a E.R. nor a L.T.C nurse. I work on a cardiac step-down unit for the most part I "receive" report.

We have two local hospital's that give us "poor" reports consistently. One of our nurses was mentioning the hospital I previously worked at and how poor their reports were. That unit was so understaffed that you could barely make it through a shift. I didn't "work" per se on that floor but was pulled their a lot.

:)

[night owl]

Be Prepared: Have the info ready when you call the ER...Keep a little card in your pocket for when emergencies occur so that you can read this info off... fill in the blanks with:

YOUR NAME,TITLE____

FACILITY FROM WHERE YOU'RE CALLING FROM_____

PT's NAME, AGE, SS#,DX_____

PRESENTING s/s______(when did they start)

RECENT vs__T__-__P__- __R__ ,__B/P,__POx__

ALLERGIES_______

ANY IV's, x-rays,etc_____.

DNR status, limited therapies, advance directives, NOK AND TEL.#

DR'S NAME WHO'S TRANSFERING RESIDENT______

ETA: Ambulance is either on their way, or we're still waiting for

them.

Tel.# from where you're calling from incase they need any more

info.

*** * *If they want a miracle, tell them to call, toll free, 1-800-THE-LORD...He'll advise! :)...only if you get "the 'tude" (Hi Rick...Love ya sweetie!)

:kiss

Have a fun-filled day!

[babynurselsa, RN]

Well when I worked ER I would have loved to have recieved pt.s from the above facilities. My experience was always: No report called. Generic paperwork that had not so much as a logo or facility name. No list of allergies or Medical Dx, we would have to deduce what the patients health history was by the meds on the MAR, if we could not pull an old chart.

From a couple of my favorite facilities they would arrive at 2200 in the evening for a geripsych eval, in that same old see-through gown, and plugged up foley with a temp of 103.

Now we did have a coule of exceptional facilities in our area that had their own paper work, with a name, logo, and even a phone number on it. A complete medical history, a current complaint transfer sheet, and a MAR, plus a DNR status form. These pts would arrive clean and in less see-through clothing.

I must admit that at times I did possibly get an attitude with some of the LTC staff, but I would always base it on the condition of the patient.

[semstr]

ok, stupid questions probably, but i don't quite understand:

1 when you work ER, do you get reports of all the people who walk in?

2 Aren't there any doctors in LTC?

3 Why are the habitants brought to the ER, when they are sob?

or something like that?

Here we have doctors 24 hours a day, people only go to the hospital for operation and return as soon as possible.

NOW, that is something I get really angry about: as soon as the wards know, a patient is from a LTC-ward, they turn them back to us, when possible straight from the recoveryroom, or the next day.

These patients are neither cleaned, washed or fed!!

It is terrible! Of course this not on all the wards.

Take care, Renee

[nursedawn67, LPN]

Where I work (LTC) when I send someone to ER, it is not because I just feel like someone else dealing with them. I call the patients doctor at home and tell them exactly what is going on the doctor does one of two things orders meds to be given or orders the Patient to be sent to ER. I call ER and tell them who I am sending over, sometimes they ask for details and sometimes they just say ok and hang up. I then fax over a copy of their advance directives, and then I copy and send with the res the advance directives (so technically they have 2 now), I copy the H & P, their current med sheets, recent labs, the charts face sheet, immunization records. I also send them the transfer paperwork with the pts vital signs taken within the past few minutes a detailed explanation of what is going on and various info about the res. If the problem with the res has been going for sometime and with other shifts I copy the nurses notes and send them. What I have described is standard practice for all of our nursing staff when transferring to ER. Everywhere we go we will find somebody that should not under any circumstances be working there. We are all part of a team to save lives and help others, why is it we feel the need to be competitive with eachother?

[night owl]

greer128,

Our facility does exactly what you describe when sending a pt to ER for eval. Plus we give a full verbal report over the phone. I don't think anyone is competition here, the ER is just fed up with getting lame reports from some lame nurses from LTC facilities. I work in one and believe me, Ive worked with a few of those lame nurses! Some just need to have better and more detailed communication skills. We need to work together for the wellbeing of the pt. Don't take this thread personally, it wasn't ment for ALLNURSES in all LTC. Smile, we still love you!

[catlady, BSN, RN]

I am a unit manager in LTC with many years of ICU experience. We don't call report to the ER--we give report to the ambulance service over the phone, write a detailed W-10, and give a verbal report to the paramedics when they come to pick up the resident. If the ER has questions, they call us. Sometimes we get a snotty attitude from the ambulance team...often because we tell the dispatcher that we don't need lights and sirens and they show up running for the fire, or vice versa. Other times they get annoyed because the resident looks better/worse than they did when we called for the ambulance. People's conditions *do* change. And sometimes we're sending them because the doctor doesn't want to deal with them, or the family is making the doctor's life miserable, even though the resident doesn't appear all that ill.

The only time I've ever sent a resident without a doctor's order is when I felt the resident was too unstable for me to wait for the doctor to return the call, and then of course, the doctor has no argument with my decision. They rely on our judgment and our assessment of the situation. Hospital nurses like to think they are independent, but LTC nurses really are. And as a long-time hospital nurse, I can say that not many nurses--including the superstars of the ER--are all that wonderful at giving report...certainly not wonderful enough to be criticizing anyone else. I have called the ERs many times to check on the status of my resident, and usually I get jerked around, transferred six times, and often never get to talk to anyone at all.

I wish different specialties would quit sniping at each other. We're not better or worse, just different.

[4XNURSE]

Originally posted by catlady

.....I wish different specialties would quit sniping at each other. We're not better or worse, just different. [/b]

Very well stated Catlady. I wish I could remember this at the times I get connected with a nurse who is having an bad day that happens to be on the same day I'm not tolerant enough.

You know, this forum is good for me. I'm learning a lot from all of you. - Thanks!

ken:devil:

[Rustyhammer]

I work in a LTC facility and we have a few lame nurses here who I wouldn't doubt would send a resident to the ER without a phone report or proper paperwork etc...

These people are an embarrassment to the Nursing Center and generate the type of turmoil we see in this thread.

Sure, we'd like to give them their walking papers and only hire those with good skills and pride in there work but the workforce isn't there and like it or not sometimes you are "stuck" with the "lame nurse".

I offer my apology to those ER nurses who get dumped on by the nurse (and I use the term loosely) from the nursing home. We'd love to give them the boot but we are already working 50-60 hours a week as it is. (Funny how the lame ones are never available to do those extra shifts...probably for the best).

-Russell