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All staff matter :)

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by %D#2 %D#2 (Member)

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1pinknurse has 7 years experience and specializes in 4.

366 Posts; 6,598 Profile Views

One thing that I have to explain to other nurses at times is that I have my own license to worry about, so don't worry about me f*cking yours up. Plain & simple..sometimes people need to be swiftly reminded to shut up. You totally did the right thing and you are the nurse!

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beckysue920 specializes in Psych, HIV/AIDS.

114 Posts; 5,136 Profile Views

You did good!! Wouldn't it be nice to get an apology from that RN??

 

So glad your patient is okay.

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics.

2,893 Posts; 28,885 Profile Views

I work in LTC as well and you absolutely did the right thing. We don't have the diagnostic equipment the hospital has, nor do we have a doctor in the building. If in doubt, send them out.

Though I will admit the times I have sent out a confused way beyond their norm resident that miraculously recovered for the EMT's and was fine by the time they hit the ER I did feel kind of silly pretty much saying "honest, he wasn't like that when I called." Though I'd still rather be wrong than watch somebody tank because I didn't take a change of condition seriously enough.

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Scarlettz has 4 years experience and specializes in Med-Surg, Psychiatric.

248 Posts; 6,784 Profile Views

You did the right thing and don't let some miserable nurse get you down! I have much respect for LTC nurses because they do not have the same resources a hospital does. You know your patient and his baseline. If I were this patient's daughter, I would have thanked you for caring enough to take my family member's complaints serious. And kudos to you for being mature and professional towards the nurse - even though she was not to you. I am sorry for that.

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KelRN215 has 10 years experience as a BSN, RN and specializes in Pedi.

1 Article; 7,344 Posts; 67,644 Profile Views

Wouldn't the ER rather evaluate a patient for chest pain and have it turn out to be nothing than have a patient die because his symptoms were passed off for GERD?

Last year, when I was a visiting nurse, I had a baby with myelomeningocele and untreated hydrocephalus. Though the symptoms of increased ICP had been reviewed with his family ad nauseum, they just didn't get it. When I went by for a scheduled visit, I found him with a neighbor. He had been crying all day, his head circumference was up, he had no upgaze and the neighbor reported that he had been vomiting with every bottle. I spoke with the on-call Neurosurgery NP who agreed that he needed to be sent to the ER. This was a social disaster situation. The kid's mother was in rehab, the father wasn't home but even if I could get him home wasn't a licensed driver and the neighbor had no way to get him to the hospital. Oh and did I mention he'd been dropped the week before and had a healing skull fracture and resolving bleed? So I called 911. When I told his primary team what had happened, he thought it was probably time for hydrocephalus to be treated. The on-call Neurosurgeon decided to chalk all this up to "an overreaction on the part of the visiting nurse." That was probably the maddest I'd ever been. (Well that, or the time a Neurosurgery Resident told me "don't worry about it" when I had a different hydrocephalus patient who clearly needed emergency surgery.) I put him in his place by telling him that there was no way I was going to leave the baby with a neighbor who'd let him cry and vomit all day hoping that eventually a responsible adult with a license would show up to drive them to the hospital. Oh and this baby did end up needing surgery for his hydrocephalus a couple months later. He was also taken into state custody shortly after the aforementioned event. But I'm sure I was just overreacting...

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BuckyBadgerRN has 4 years experience as a ASN, RN and specializes in HH, Peds, Rehab, Clinical.

3,520 Posts; 37,724 Profile Views

While you did the right thing, it's concerning that there is no rn in your facility. In my state Lpn's cannot assess. They can gather information, but not assess in the legal sense of the word. An rn must be physically present in the facility here

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LPNtoRNin2016OH has 5 years experience as a LPN and specializes in Allergy/ENT, Occ Health, LTC/Skilled.

1 Article; 541 Posts; 16,908 Profile Views

Great job! All of us, LPNs and RNs, catch crap from the ER nurses when we send them in from LTC. There have been a few times it wasn't an immediate emergency but we had to send them in because we were unable to rectify the problem in house during the weekend and it couldn't wait till Monday so now we get all kinds of huffiness. But we always run it past the DON if there isn't chest pain/respiratory distress (obviously we make the call on our own then) and if she says send them, we do. I had an MD get all kinds of pissy last night when I had a call in for a suspected bowel obstruction. That's what annoys me, I'm not going to feel bad for calling in on the weekend when my ass is on the line and my patient could have a life threatening problem. Thankfully he was just very impacted even after giving him suppositories and an enema, but we can't know that for sure unless we can get the order for a STAT scan. Some people are just grumpy no matter who is asking, so just shake it off, you did a good job.

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LPNtoRNin2016OH has 5 years experience as a LPN and specializes in Allergy/ENT, Occ Health, LTC/Skilled.

1 Article; 541 Posts; 16,908 Profile Views

While you did the right thing, it's concerning that there is no rn in your facility. In my state Lpn's cannot assess. They can gather information, but not assess in the legal sense of the word. An rn must be physically present in the facility here

This is state dependent. We have to have a certain amount of RN hours and an on call RN on the weekend but generally the only staff where I work on the weekends are LPNs.

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1,763 Posts; 20,381 Profile Views

While you did the right thing, it's concerning that there is no rn in your facility. In my state Lpn's cannot assess. They can gather information, but not assess in the legal sense of the word. An rn must be physically present in the facility here

It's concerning to me that you are under the misconception that every state operates exactly as yours does.

http://ltcombudsman.org/uploads/files/support/Harrington-state-staffing-table-2010_(1).pdf

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kbrn2002 has 25 years experience as a ADN, RN and specializes in Geriatrics.

2,893 Posts; 28,885 Profile Views

While you did the right thing, it's concerning that there is no rn in your facility. In my state Lpn's cannot assess. They can gather information, but not assess in the legal sense of the word. An rn must be physically present in the facility here

Not necessarily. While an RN must do the actual assessments we are only required to have one on call. Unless there is an active IV in the building, in that case an RN must always be on the premises on not just on call. We still occasionally staff LPN's only on NOCS, it certainty isn't the preference but we have to work with the staff we have.

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1056chris specializes in med/surg.

68 Posts; 1,921 Profile Views

I have been an RN 26 years(mostly med-surg) You did the right thing. Even with the PMH of GERD, the vitals indicated something, as well as your assessment of the location of the pain, and your general knowledge of your patient They should be thanking you. You also display a characteristic that some nurses forget with modular nursing, your a team player. Respect the staff that works around get to know them and help them when you can, they will respect you and help you in return. Most of all your patients in the unit will be taken care of , and you will learn a lot of things along the way. Good Luck

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OldGrayNurse has 27 years experience and specializes in Medicare Reimbursement; MDS/RAI.

50 Posts; 1,835 Profile Views

I find, in many instances, it is simply a matter of perspective; ER nurses don't understand LTC's don't have a doc on site 24/7. In most cases, they round monthly, and you bet your sweet tootie they aren't going to come out to see someone sick other than if they are on site for rounds. They are quick to tell you to send them to the ER. :yes:

Hospital nurses, unless they worked LTC in the past or work part time at one, in general lack understanding of how things work in a long-term medical facility. And, I might add just so I don't get whacked, vice verse. When we work in one institutional setting, we tend to get tunnel vision as to how things work and forget all nurses (and the places that employ them) are not alike. :no:

Heck, I just today had a case manager try to send me someone straight out of CVICU. We don't accept patients coming straight from a specialized unit (with the exception being geri-psych) because they tend to be still a tad more acute than a nurse working 1:22 (or 1:44) nurse to patient ratios can safely monitor. Hospital case manager was new, hospital nurse was new, hospitalist doc discharging wasn't acclimated to long term care, and you have a perfect cluster.....

I'm trying to say....it's easy when you're working in an ER to assume you have a practitioner you can just summon when you like; and it's easy when you work in LTC to assume the hospital knows your long-standing rules. Kudos to you for keeping your wits about you and not trying to crawl through the phone Nurse Jackie style and throttling her.:madface:

Still, she shouldn't have jumped to conclusions. I have often wished, in my almost 30 years of nursing, that nurses could kind of "shadow" one another in a completely different setting a day or two a year just to get the gist of how other settings flow.

I, personally, would love to "shadow" the EMT/paramedic/medical transport personnel a couple of times to find out how all my patients get those nasty decubitus ulcers on the short ride from the hospital to the nursing home.....and vice verse. :cheeky:

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