When I worked LTC, I sent anyone out who needed treatment or labs that we could not give in a timely manner.
For instance, our turnaround for a stat lab draw was over 24 hours (best case scenario
). A hospital's is about 2 hours. If someone looked like they were anemic and needed blood, or had to have a sputum culture or a chest x ray asap --whatever, we sent them out.
Some of the ER nurses might have disagreed with that decision, as a lot of our folks were DNR's, but we always called their families or POA's before we sent and asked, "Do you want this treated?" In some cases, the family would insist on sending them out. Since the ER doesn't always get the whole story, they shouldn't try to judge you like that.
And because you are the one responsible for your patients, you shouldn't let "what the ER will think" affect your decision.