Advice to the LTC nurse...

[southernbeegirl]

Hi guys! I have worked in LTC for 16 yrs. I have listened to ER nurses, EMTs, paramedics talk about "nursing home" nurses. I have worked hard to develop a good working relationship with the on call docs that my facility uses, the local EMS and ER depts. I'm always trying to improve my communication skills with them. I also would like to help the nurses improve their phone skills to relay what is pertinent to the situation. (I am the nursing manager).

I don't mean this thread to turn into a nursing home nurse bashing but I won't get my feelings hurt by fellow nurses expressing their frustrations with us.

Do you have any advice for those of us in LTC?

[southernbeegirl, BSN, RN]

Thank you guys so much for all the replies! I have shared much of this with my coworkers. I think we are doing a much better job.

As for the poster that stated something about us sending dying, DNR patients to the ER. Please believe you me...it is NOT our idea. We feel like idiots doing this. Sometimes you just have no choice when a family is faced with the impending death of their mom/dad and they suddenly want them transferred. Sometimes no matter what you say, it won't change their mind or help them accept it any better. I always try to be honest about this when I call report but whatcha gonna do, ya know?

I recently had a wife change her husband to a full code while he was on the stretcher dead as a doornail. ugh.

[southernbeegirl, BSN, RN]

A good report tells us what the current complaint is. As others have said: what is normal for this pt & what is different today. A brief medical history is good, including vaccinations & a legible list of current medications. Also helpful if SNF contacts family, at least with those pts where family is likely to come to ER to be with pt. It seems like I usually get either not enough info ("pt not himself today") or too much (10 handwritten pages of hx, meds, etc.). We try to return pt to SNF with typed DC instructions & prescriptions. What info do SNF nurses wish we sent to them after ED visit?

We have no choice about our "handwritten" orders. Although hospitals are completely online, SNFs are not. When we get an admission, the entire process much be handwritten by us. A normal SNF admit takes 2 hours minimum to complete and it is all handwritten. Our pharmacies only print our MARS and orders once a month, at the beginnning of the month. So while we REALLY appreciate your typed orders, please don't blame us for our handwritten ones. We have no control over these things. So while we do enough to drive yall nuts, some things are out of our hands.

[southernbeegirl, BSN, RN]

I would suggest putting together a form that details a report so that you don't leave anything out...

Pts Name

Age

Drs name

Nurse name

Facility's name

phone number where you are calling report from (not the main number cause lots of times I have no idea what room the patient came from)

Is this patient a DNR?

Cheif Complaint and what you have observed and/or done to help this patient

Vtal signs

Medical diagnosis list major ones

Any recent surgeries?

Any recent abnormal labs?

Does the pt have an IV?

Any relevant meds... pt is usually alert and oriented but after the patient had Trazadone 50 mg he's obtunded.

what patient is like normally.. can they ambulate, a&ox3?

Did you call the family?

Have you called the ambulance yet?

ETA?

Please send a copy of the MAR

It sounds like a lot of work I know but once you get used to filling this thing out its less time consuming because you can just look at your sheet and talk. Or you can just fax us the sheet and if we have any questions we can call you directly because I have your entire name not just Susan and I have the phone number of your unit!

Ooh this list is great! I am so stealing it. Thanks again!

[DixieRedHead, ASN, RN]

How about the flip side! Having been on both sides of the matter I can suggest some things an ED nurse could do for the LTC.

1. Send a copy of the labs done at the hospital, Xray reports if you have them.

2. Call us a report, tell us what the patient received in the way of treatment at the ED.

3. Understand that I really don't relish send a patient to the ED. Sometimes I have no choice.

4. Please don't assume that I work in LTC because I have no choice. I am a Registered Nurse with experience in ICU, Telemetry, and the ED.

Oh, and could you please tell the EMTs that if I call for an ambulance because a patient fell and they arrive at the facility and find someone lying on the floor with pillows under their head, four or five people standing around that person with BP cuffs, stethoscope, and one leg rotated inward and shortened, their first question should not be "Is this the person that fell?"

[DixieRedHead, ASN, RN]

Oh here is a pet peeve of mine. And both disciplines are so so so guilty. When you answer your phone give me your name, your entire name, and your credentials. You know I'm going to have to ask. I can't give report to the secretary, an aide can't take orders. I only have time to say it once.

I answer the phone "Dixie Redhead RN, may I help you?" I have to chart your name and your credential to CMA and so do you. Let's get together on this!!!