ER vs. LTC Facility staff

  1. 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.
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  2. 24 Comments

  3. by   askater11
    I'm so sorry you were treated that way!!! You don't deserve that, you did what the resident wanted.

    I'm glad the nursing director talked with them.
  4. by   horsecrazy
    i'm sorry you were treated like that, i think sometimes in the heat of the moment, we sometimes say things without thinking.
    I work in ccu, but i also worked in a ltc for a brief time last summer. I live in a rural community, so the same handful of docs that work at the hospital also attend patients at the ltc's in our area.
    unfortunately doctors in general do not respect the nurses that work in ltc's here. I was attending a patient who had progressing ms when one night she became sob, I found her sat was only 85% and after listening to breath sounds found she was in pneumothrax( the right side had no breath sounds what so ever). After calling the doctor and reporting my findings, he commented are you sure you are not paranoid I'm sure she has breathsounds. I reported where i worked and he changed his tune, saying he didn't realize who i was, i said that it shouldn't had mattered.
    as everywhere there are both good nurses and mediocre nurses in all facilities, i think the medical profession can be prejudice to the nurses in ltc's.
    your patients are lucky to have you care for them.
  5. by   CEN35
    this could essentially be the longest post of my life. personally i really hate long drawn out posts. this issue has come out before, and if you look back far enough you can find the thread.

    i can back both sides of the argument.

    er - at one point and time, i beleived that er nurses were awesome. of course the staff i started with, was exceptional. over the years, i have seen some really lame people come though the er.

    ltc - at the er i work at, we get a large volume of ltc patients. when they call to give report on a ptient they are sending, they never seem to know the patient? i'll give you an example.

    "i'm calling from ******* ***** nursing home, to give report on a patient i am sending in for evaluation. he has had a fever for three days now, and we dont know why? the squad will be picking him up, in about 5 minutes. thanks"

    then i have to say...."hold on" i have to ask who is calling report, the pt's name, age, allergies, vs, dnr status and baseline ms. this seems to take a good 10 minutes?
    i get answers like, well i'll have to go get the chart, or the allergies are in the mar i am sending with him, or i'm not sure? better yet......when it is 6:30pm, and they call to give report on a patient in distress d/t sob. they say, he has a 80% pox. you ask for vs, and they say at 1200, they were 98.6f, 120/60, 82, 20??????
    at 1200? i mean really? so then ask them if they have anything more recent, and they say no and the squad just left, with the patient.
    the er is packed and we clear out a room, to hold a bed for this patient. the patient doesn't show up for 2 hours? the vs are all wnl, and the patient is nad, and the pox is 98%@.21?

    so maybe thats why we cop a tude now and then. i shouldn't say we, i should speak for myself. i cop a tude with stuff like this. i treat every nurse differently, i don't deny it. just like i treat every doc differently, some deserve respect, some need a tongue lashing.

    if the nurse clearly is on the ball, and has all the bases coverd......it's awesome. they deserve the respect.
    if they are clueless, they get the attitude. i don't deny it. it is very frustrating.
    i know my patients insdie and out, from recent vs, to labs, to 12 leads, x-rays, ct results you name it. that's part of the job.

    however, i agree, from your side of the story...sounds like they were out of line. of course they could account for a portion of the lame nurses out there.

    anyways.........this could go on forever. bottom line is, there are a fair share of great nurses, and a fair share of morons everywhere.

    for all you readers out there.......nothing i said in this post was meant or intended to offend anyobody, based on where you work or what you do. so don't be offened, just be the best at your job. :d


    just me
  6. by   nursedawn67
    yes i totally agree that there are "yahoo" nurses everywhere. and sometimes it is the patients themselves that cause the attitudes. we have a resident that had chest pain (that she swore she was dying from) that 3 nitros would not cure, the doctor was called and order was wrote to sent the pt to the er, when she got there they asked her if she was having chest pain and she said no my hip hurts! which makes the ltc nursing staff look stupid.



    originally posted by cen35
    this could essentially be the longest post of my life. personally i really hate long drawn out posts. this issue has come out before, and if you look back far enough you can find the thread.

    i can back both sides of the argument.

    er - at one point and time, i beleived that er nurses were awesome. of course the staff i started with, was exceptional. over the years, i have seen some really lame people come though the er.

    ltc - at the er i work at, we get a large volume of ltc patients. when they call to give report on a ptient they are sending, they never seem to know the patient? i'll give you an example.

    "i'm calling from ******* ***** nursing home, to give report on a patient i am sending in for evaluation. he has had a fever for three days now, and we dont know why? the squad will be picking him up, in about 5 minutes. thanks"

    then i have to say...."hold on" i have to ask who is calling report, the pt's name, age, allergies, vs, dnr status and baseline ms. this seems to take a good 10 minutes?
    i get answers like, well i'll have to go get the chart, or the allergies are in the mar i am sending with him, or i'm not sure? better yet......when it is 6:30pm, and they call to give report on a patient in distress d/t sob. they say, he has a 80% pox. you ask for vs, and they say at 1200, they were 98.6f, 120/60, 82, 20??????
    at 1200? i mean really? so then ask them if they have anything more recent, and they say no and the squad just left, with the patient.
    the er is packed and we clear out a room, to hold a bed for this patient. the patient doesn't show up for 2 hours? the vs are all wnl, and the patient is nad, and the pox is 98%@.21?

    so maybe thats why we cop a tude now and then. i shouldn't say we, i should speak for myself. i cop a tude with stuff like this. i treat every nurse differently, i don't deny it. just like i treat every doc differently, some deserve respect, some need a tongue lashing.

    if the nurse clearly is on the ball, and has all the bases coverd......it's awesome. they deserve the respect.
    if they are clueless, they get the attitude. i don't deny it. it is very frustrating.
    i know my patients insdie and out, from recent vs, to labs, to 12 leads, x-rays, ct results you name it. that's part of the job.

    however, i agree, from your side of the story...sounds like they were out of line. of course they could account for a portion of the lame nurses out there.

    anyways.........this could go on forever. bottom line is, there are a fair share of great nurses, and a fair share of morons everywhere.

    for all you readers out there.......nothing i said in this post was meant or intended to offend anyobody, based on where you work or what you do. so don't be offened, just be the best at your job. :d


    just me
  7. by   askater11
    Regarding reports being called.

    We get a lot of transfers. A lot of transfer's I've noted "quality" report from some hospitals and less then quality from others. And a lot of it is related to nurse patient ratio. Not necessarily "good"/"bad" nurse, but I'm sure that's not always the case.

    I have never once "copped" an attitude with a nurse. I will ask all pertinent questions. They will get the chart and questions will be answered.
  8. by   ComicRN
    Ok............at the risk of starting "something" here, I'm going to put my two cents in! I've worked on a med/surg floor, in rehab and currently work as a clinical coordinator in a LTC facility. Know what my pet peeve is? When we call to get report (or the hospital calls US with report) on an incoming admission and the nurse says, "well, I don't know, this is my first day with this patient." OK...I understand THAT part of it, but I think the next line should be, "but I'll find out the answer to that question and get back to you." Would that same nurse say that to a doctor, or a family member? I don't think so. So, why can't we give our fellow nurses the same courtesy?
  9. by   cinny071
    I am a Unit/Ward Clerk in LTC. When we send a pt. to the ER or any hospital/office/clinic/etc.
    We copy the most recent info on the chart,Dr. orders,p/h.progress notes,nurses notes, TPR sheet and anything and everything else we think could be needed aslo do a Transfer Sheet(the RN).
    And the RN always calls the ER and gives a verbal report with chart in front of them. In know this is how we do it.

    By the way we get great feed back on the info we seed with our patients ( I always tell the other places I deal with if you don't have the info you need please call and it will be faxed to you ASAP). Get very few calls.
  10. by   cinny071
    Oh my, my spelling is bad tonight! Must be Brain Fog!!
  11. by   P_RN
    My DHs father had a long history of heart trouble with several MIs. I called his doctor once when in my opinion he had another cardiac event. The on call doctor returned my call, and when I told him ALL the info....he answered with "What are you some G-D know it all nurse or something?"

    I said .....oh never mind what I said. I never did have any respect for that Jack*** after that.

    And yes, he had another MI and passed away a week later.

    It only takes common courtesy to avoid 99.9% of all the miscommunication in this world.
  12. by   hpyrn
    I AM A RN SUPERVISOR ON A SKILLED NURSING UNIT IN A LTC FACILITY. I USUALLY WORK THE FLOOR CARING FOR 23-25 PT.'. I AM ALSO USUALLY FOR SOME PORTION OF MY 12 HR SHIFT THE ONLY RN IN OUR 150 BED FACILITY. I AM SO TIRED OF OTHER NURSES THAT WORK IN A FREAKING HOSPITAL ACTING LIKE WHAT I DO HAS NO MERIT, I WORKED IN THE LOCAL HOSPITAL AND THE FIRST NIGHT OF ORIENTATION HAD 8 OF MY OWN PT'S AND RAN CIRCLES AROUND THE OTHER NEW NURSES THAT WERE WORKING ON A VERY HIGHLY ACCREDITED STROKE UNIT. I DO THE SAME THING YOU DO, IF I CALL REPORT YOU KNOW EVERYTHING FROM WHAT HIS LAST MEAL WAS TO THE LAST TIME HE THOUGHT ABOUT TAKING A CRAP, GET REAL, EITHER YOUR A GOOD NURSE OR YOUR NOT, ITS NOT ABOUT WHERE YOU DECIDE TO DO IT.
  13. by   CEN35
    hpyrn - isn't that what i said??? i applaud you! btw....that is not sarcasm but sincerety.

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

    You go girl!!!!!

    P

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ER vs. LTC Facility staff