Skilled LTC facilities that don't want to perform any "skills"? - page 2

by ceecel.dee

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We continually have trouble transfering hospital patients to a few of our local NH's if the patient has any skilled "nursing" need. Of course almost all of the transfers have PT/OT referals, and they welcome that, but IV... Read More


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    Originally posted by Hellllllo Nurse
    When I worked LTC, we did all of the above things you mentioned, routinely. Also trach care, TPN, etc.

    Just had a "skilled" facility agree to do peritoneal dialysis on a pt, then boot her out after she'd had the surgery.

    I thought a SNF had to have an Rn on duty 24 hrs, especially for medicare. At least in Illinois.
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    re: the above SN issues. i am at a LTC/rehab facility and we consider ourselves skilled. i am IV certified and did home care for 12 years so i have no problem with TPN, IV antibiotics, trach care, or wound vacs, but many of the nurses would rather send the patient back to the hospital than start an IV to rehydrate or treat with antibiotics. our RNs are in-house only 8 hours per day so the LVNs are on their own after that. i'm one of probably 3 nurses that will start their own IVs. and....on that issue of keeping that patient overnight...can we say SHE PROBABLY DIDN'T WANT TO DO THE PAPERWORK. i am of the opinion that people are basically incompetent and given the opportunity to mess up, we usually do. a lot of nurses lack self-confidence as lvns. maybe when i get my degree i can change that in some minute way.
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    medicare requires RN coverage 8 out of 24 hours in TX. that's why we have weekend supervisors.
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    So much going thru. my head It's hard to reply to this one.

    Medicare reimbursment in Michigan - WOW thats thread in it's self.

    Skilled Nursing - Skilled I can't find any nurses that can do an admission let alone take care of them.

    Many Nursing homes market themselves as skilled - but have been performing custodial care so long they aren't educated on what's new in the world. (not enough time or funding for proper continuing edu)

    Others like mine have skilled residents. Trachs, peg tubes, J tubes, IVs, pressure sores, HIV, Hepatitis, Huntingtons Chorea (help), closed head injuries, rehab, PICC lines, Borderline Personality disorsers, Alz. Schitzophrenia, ect,,,,,, We tried to go more acute but the Nurse to Patient ratios (oh my god)! I tried to take a complicated closed head injury with P&PD. what a nightmare. On top of all his wounds, peg tube, meds, constant turning, P&PD q 4 2-4 hrs along with trach sxn prn, constant fevers of unk origin, The fight with the Dr, about how to do P&PD q 2-4 hours inbetween proper posit. for tube feeding to avoid asp. and stopping pump for one hour to adm. dilantin. Goes on and on, just this one patient, on top of 30 -40 other residents, remember ratios get higher on off shifts.

    Well lets say I will never take another P&PD like that. I had nurses refuse to take the assigment because they were woried about their licenses.
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    i guess the facilities can pick, choose and refuse. as far as iv's are concerned some facilities dont want to staff the place round the clock with rn's to look after them. i'd much rather hear of a ltc facility refusing an admission than accepting one that they cant take care of. in my rural ltc we had pts. that required suctioning and the lvn's actually thought that it was not in their scope to do that and were always asking the rn's. i was in the education department and got "annie" out and gave them (the lvn's) an inservice on suctioning and told them to come back with a sheet signed off by an rn that they had done at least 3. however we do have a 100% passing rate on the lvn boards at our local community college. a lot of didactic but limited clinical experience.
    Quote from ceecel.dee
    we continually have trouble transfering hospital patients to a few of our local nh's if the patient has any skilled "nursing" need. of course almost all of the transfers have pt/ot referals, and they welcome that, but iv antibiotic tx?, sterile dressing changes?, tube feedings?, picc line?, central line dressing changes? no thanks, no thanks, no thanks, no thanks, and again, no thanks!
    today, one of their patients came as an outpatient for picc line insertion, and the charge nurse called to say, "i really think he should stay the night to stablize". "stablize?! he's not, nor has been, unstable! he is being d/c'd right now and we have sent along our routine care of the line, and detailed instructions on his antibx and it's infusion. call us anytime with questions or in need of any support."

    do you guys deal with this? is this the way it is everywhere? thanks for any insight!
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    From the other side of the fence- I was working in a LTC facility- with 37 patients on my hall. 4 of which were Gtube feeders requiring bolus feeds q4h, I had 2 IVs, astronomical wounds, about 75% needed their meds crushed & encouragement to take their meds. I was always hurrying all the time, missed breaks, and never finished my paperwork at the end of my 8hr shift. skilled patients in LTC fine....but there needs to be a better nurse to patient ratio.
  7. 0
    Quote from ceecel.dee
    We continually have trouble transfering hospital patients to a few of our local NH's if the patient has any skilled "nursing" need. Of course almost all of the transfers have PT/OT referals, and they welcome that, but IV antibiotic tx?, sterile dressing changes?, tube feedings?, PICC line?, central line dressing changes? No thanks, no thanks, no thanks, no thanks, and again, no thanks!

    Today, one of their patients came as an outpatient for PICC line insertion, and the charge nurse called to say, "I really think he should stay the night to stablize". "Stablize?! He's not, nor has been, unstable! He is being D/C'd right now and we have sent along our routine care of the line, and detailed instructions on his antibx and it's infusion. Call us anytime with questions or in need of any support."

    Do you guys deal with this? Is this the way it is everywhere? Thanks for any insight!
    I know what you mean they will not admit a patient to our facility if they need an NG TUBE like we don't know how to manage these???


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