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AnnieOaklyRN, BSN, RN, EMT-P 20,925 Views

Joined Oct 24, '06. AnnieOaklyRN is a RN, Paramedic. She has 'Previously ER RN, 17 years in EMS (yes, I still love it) , IV RN 8 months!' year(s) of experience and specializes in 'IV RN, (911) Paramedic'. Posts: 1,979 (31% Liked) Likes: 2,127

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  • Feb 11

    There are two sides to every story.... As a paramedic here are some examples why I have little faith on nursing homes!

    1) Called to a nursing home for a "hypoxic" patient with respiratory distress and a history Huntington's Disease. Arrive to find a 40ish year old patient in a diaper only lying in a bed, with no clothes on, and with NO blankets to be found and the air condition on around 60 degrees. (NO I am not exaggerating or making this up). The nursing home nurse relates the patient is "cyanotic, but he won't let me put a nasal cannula on him, as he keeps taking it off." This patient had advanced Huntington's and could no longer walk or talk. My partner and I look at the patent who has NO central cyanosis, but who has blue, cold extremities. Not a single nurse at this facility could figure out that this patient was hypothermic from the environment they set up!!! The patient was not cyanotic and not hypoxic, he had a RR of about 15-20! So we transported this patient so he could actually get some clothes put on him and a blanket, and a warm environment!

    2) Called to a nursing home for a cardiac arrest. Told by the nursing home nurses that "we just saw him ten minutes ago and he was fine". My partner and I get in the room to find a pulseless and apneic elderly patient lying in the bed with FULL RIGOR MORTUS!! You saw him ten minutes ago? really? Again, this is a true story!

    3) Called to another nursing home for a cardiac arrest. Arrive to be told that the staff have been doing CPR for 45 MINUTES! Yes, that is right, 45 minutes! When I asked why they did not call us immediately I was told by the nurse that she was waiting to get a hold of the doctor for an order to transport to the hospital! So, you think this patient is still viable after you have been doing CPR for 45 minutes on the soft mattress???!!

    5) If I got a dollar for every time a nursing home staff member said "I don't usually work this floor, so I don't know". "This is my first day on this floor, so I don't know". "This patient just got here, so I don't know"... the list goes on. This is why we lack respect for nursing home staff, because you do not prove to us that you are knowledgeable and skilled at caring for your patients. I get that you have a large patient load, but the examples above are ALL true experiences that just I have had. So when you pass out medications, you don't note the patient's condition or mental status? Are you just robots essentially?

    When we ask what the patient's baseline mental status is and you say "I don't know", that doesn't help us, because you need to either find out! You are calling for "altered mental status", how do you know if you do not know what their baseline is???? Heck, ask one of the CNAs they deal with them everyday! When your answer to almost every question we ask of you is " I don't know" followed by an excuse, no we won't have respect for you or your staff. When you are asking if you can have your NON-REUSABLE BVM back to reuse (this has happened numerous times), no we won't have respect for you. when we regularly see patient's at the nursing home with respiratory distress on a non-rebreather at 6 LPM, no we won't have respect. (especially when I have specifically told you in the past that you are suffocating the patient and giving them less oxygen than is in the atmosphere)! When it's clear that no critical thinking is happening, no we will not have respect for you.

    Respect is given and earned over time. If we consistently go to your facility and have these experiences, which unfortunately is happening all over the country everyday, we won't respect you. Would you expect a patient to respect me and have faith in my abilities if my answer was "I don't know" to every question I asked of them?


    Do I think any of this warrants rude behavior at the time of the call absolutely not, but understand that the general lack of critical thinking or knowledge we seem to experience in SOME nursing homes/rehabs is very frustrating to EMS staff, who just want to do what is best for the patient.


    Annie

  • Feb 9

    hi,

    I am not only a nurse, but also a paramedic and have been involved with EMS for 9 years. I have had plenty of nursing home nurses be just as rude and snotty towards me!! So it DOES go both ways, and when you read the following ACTUAL reasons given to me for the patient needing transport to the hospital you may actually understand why we can get rude.. No offence to nursing home nurses, but I have found that som!!e are not so good at patient assessment... Also it is hard to respect a profession when all I get just about every time I ask a question is "I am new to this floor" "I normally do not work on this floor" or "The patient is new here", now I am not asking for the world here, just some basic history on the patient, like their baseline mental status.... Anyway here is my list of true tails from my EMS related visits to nursing homes.

    1) The pulse ox says his sat is 80 - Patient assessment= 70 something year old gentlemen speaking complete sentences , alert and orirented, pink, warm, and dry. clear LS- MY o2 sat with the same machine - 88%, hmmm lets try some new batteries.... OH MY the batteries fixed the patients oxygen saturation, he is now sating at 97% on room air- go figure, oh and the nurse still insisted that this patient go to the hospital, he was promptly returned within 15 minutes!! If I got a dollar for everytime some nursing home staff members assessed the pulse ox and not the patient I would be a millionaire, and this oppinion continues now that I work as an ER nurse!!!

    2) Report from nursing home nurse: Patient's limbs are "cyanotic" and his pulse ox is low, but he says he is not having any trouble breathing, I put a nasal cannula on him, but he keeps insisting on taking it off saying he is not having trouble breath. I walked into this room (keep in mind it is summer) it had to be about 30 degrees in the room (AC is cranked), patient has advanced huntingtons and is only in a diaper. Limbs are cyanotic and cold BECAUSE THE PATIENT WAS HYPOTHERMIC, not hypoxic!!!!!

    3) Patients labs are "off"... Patient taken to ER, labs are fine, Labs were so off that the patient should have been dead nad it was quite obvious that the blood was hemalyzed.

    4) Report from nurse: Patient fell 24 HOURS ago and we just decided to xray her hip because she cant walk or get up... I walk in the room leg is shortned and rotated, um yes, we really needed and xray to know that the patient needs to go to a hospital since the hip is obvious fx and or dislocated. I would also be a milionaire if I got paid each time this happened, yet we get called when the resident has a scratch on their arm.

    5) Called to nursing home for a code. on arrival asked how long CPR had been going on, I got an answer of 45 minutes, after pinching myself to make sure this wasn't just a weird dream and realizing that it wasnt I asked the nurese why they had been doing CPR for fourtey five minutes without calling 911 so maybe the patient would have an increase chance of survival since they woul receive ACLS (meds, intubation etc), the nurse replied: Oh, I wanted to get an order from the doctor to send the patient to the hospital.

    These are only 5 examples of the many I have expereinced over the last few years, and yes they are all true stories!

    I am not trying to bad mouth nurses here (especially since I am one), but since you are bad mouthing and generalizing EMTs and paramedics, I feel the need to do the same to LTC nurse, and maybe after reading my post you will understand how many NEEDLESS transports we get out of nursing homes, while other patients who do need to go to a hospital (ie. the hip fx's) are made to lay in bed and suffer for hours because someone doesn't know how to assess for hip fractures (they are really easy to spot).

    So next time remember there are two sides to every story, and those EMTs and paramedics may be on there 5th nursing home run, and maybe there 5th uneccasary (SP) transport.


    Sweetooth

  • Feb 8

    "Looks so much nicer out here since they installed the Versed wall atomizers."

  • Feb 6

    Work A lot and spend less, that is what I did. Took 18 long years, but I am loan free, and took out zero loans for my RN-BSN! I worked like 80 hours a week though as a medic to do it because it cost 12 grand!

    Annie

  • Feb 6

    Work A lot and spend less, that is what I did. Took 18 long years, but I am loan free, and took out zero loans for my RN-BSN! I worked like 80 hours a week though as a medic to do it because it cost 12 grand!

    Annie

  • Feb 6

    Work A lot and spend less, that is what I did. Took 18 long years, but I am loan free, and took out zero loans for my RN-BSN! I worked like 80 hours a week though as a medic to do it because it cost 12 grand!

    Annie

  • Feb 6

    Work A lot and spend less, that is what I did. Took 18 long years, but I am loan free, and took out zero loans for my RN-BSN! I worked like 80 hours a week though as a medic to do it because it cost 12 grand!

    Annie

  • Jan 31

    If you contact the user Boraz on here he or she had one that they were sending to people. There may actually even be a link somewhere in one of the threads, so I would look at the last 3-4 pages of them to see. I think it was labeled "NICU BRAIN".


    Annie

  • Jan 27

    "Looks so much nicer out here since they installed the Versed wall atomizers."

  • Jan 26

    "Looks so much nicer out here since they installed the Versed wall atomizers."

  • Jan 26

    "Looks so much nicer out here since they installed the Versed wall atomizers."

  • Jan 25

    "I am going to pick the flower that best represents my level of stress and anxiety from working here and give it to human resources!"

  • Jan 20

    Trying working in EMS BEFORE You complain!! I have been doing this for 18 years, 12 as a paramedic and am still in the LOW 20s range for pay per an hour!!! I have a two year paramedic degree, same as some nurses and tons of responsibility. I feel like part of how well you get paid is how many people are willing to do the job for crappy pay.

    EMS is fun, I won't lie and nursing sucks in my opinion, thus nurses make more because if you didn't pay them more they wouldn't do the job. It's not all about what sex dominates the profession or how much education is needed to do it.

    Annie

  • Jan 18

    I even went back to school and obtained by BSN since in this area you will never be hired into a NICU without it... but still, nothing! I am taking NRP in Feb so maybe that will help.

    Annie

  • Jan 17

    "I am going to pick the flower that best represents my level of stress and anxiety from working here and give it to human resources!"


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