Disrespect of LTC nurses by acute care (even though BMs neglected in hospitals)

[FireStarterRN]

Kind here continuation of my BM thread, where I brought up that fact that I think BMs are being sorely neglected in the acute care setting.

I had a patient yesterday who was slated to be transfered for a week or two at a nursing home. He was a CHFer, with a 23% ejection fraction and pretty bad left ventricular failure, in addition to venous insufficiency, diabetis, etc and so forth. His massive abdomin wasn't helping matters, and to top it off, naturally his bowel function had been ignored during his hospital stay. No one had bothered to request or start a bowel protocol sheet for him and he admitted when I brought up the subject that he probably needed some help.

I mentioned to the other nurse that I was going to get his bowels going. I said to her that I thought we sometimes didn't pay enough attention to bowels. She kind of laughed it off, saying in essense that we had more important things to do, like making sure they are still breathing. I said that in LTC they really are on top of keeping the bowels going. I told her that I thought it would be nice to make sure the patient had a BM before sending him to the nursing home. She made some snotty remark about the inferiority of nursing home nurses, so I dropped the subject.

I mentioned in report what I had done thus far (patient still needed a BM) and how it would be nice to maybe give a fleets to help get things going before the nursing home transfer. Once again I got this elitist attitude regarding LTC nurses, and I got the feeling like they didn't want to deal with anything so mundane as getting this poor fellow's bowels going.

I think the different disciplines of nursing should be more collaberative and supportive of one another, and of the greater good of the patient's well being.

[UM Review RN, ASN, RN]

I ask each patient during my assessment if they have any constipation, diarrhea, and when was the last BM.

That's just part of the abdominal assessment.

I'm surprised that anyone would give you any attitude about it.

Or maybe they've never seen a LTC patient vomit feces before. Believe me, it's a lot less messy coming out the right end.

[Nurset1981]

Ah, it always comes back to poo doesn't it? As a long time LTC nurse, I hear what you're saying loud and clear! Keep tracking those BM'S! I'd want someone to make sure I'm pooing if I couldn't. Happy New Year!

[pickledpepperRN]

One shift in SNF that had a BM log I had to stop and think.

I knew I had flushed a BM but it was mine!

[SuesquatchRN, BSN, RN]

One shift in SNF that had a BM log I had to stop and think.

I knew I had flushed a BM but it was mine!

*snort*

[Medic/Nurse, BSN, RN]

I, too, hate elitist attitudes in nursing - or anywhere else for that matter.

First, on the subject of disrespect of LTC nurses by acute care nurses (and others).

Yes, I think that it happens on many levels (not just poo). Just the other day, I had a paramedic get all distressed with a local ECF staff (RN and CNA). The medic just could not understand HOW the ECF staff could have not been able to manage stabilization/immobilization of a patients cervical spine (I was not on scene, so I have no idea what, if anything, went awry). He was in a fizz. Finally, not being able to stand one more second of the tirade I just stated the obvious - the ECF/LTC RN's and staff live in a different world than the pre-hospital folks. Actions like acute trauma management and full blown resuscitation are COMMON in my world and infrequent (thankfully) in "their" world. And NO, I explained - nursing school DOES NOT teach anyone to care for either set of patient realities. Nursing school teaches fundamentals and process - not practice speciality.

I have been witness to ED actions that are not kind or flattering to ECF/LTC nurses. They have made me ashamed on more than one occasion. I think that ignorance is to blame. I cannot and will not judge any nurses actions/inaction by my "practice" standards. (This is not to say that acute care nurses that work with me - are "off the hook". Responsibility and accountability exist in every nursing speciality - so everyone needs to "bring it" everyday - no matter where you work!)

The bottom line is that we care for patients. Different patients, differently. What each of us do is VITAL to our patients.

Now, onto the poo!

I agree that we do "neglect" certain things due to "focus" on immediate concerns. Some of this is not intentional, but just necessary due to multiple constraints. Not making excuses - just noting the reason. I agree that no poo = bad for patient.

LESSON: I had an abdominal pain patient in the ED that required large amounts of narcs for pain control (patient had home narcs for chronic pain). Suddenly, the patient starts screaming, the wife runs out to get me and I swear I thought the patient was not going to be long in the world (he looked that bad). The patient and wife were screaming for pain meds - I managed to get an order for and push 2 mg of Dilaudid "paramedic speed" in the melee. Turns out the patient was pooing . A 4" in diameter and approx 18" long "mega turd". (I am a girl, so I know this is a really accurate measure by observation alone ) Turns out he fell "off the wagon" with his "bowel regimen" LOL. So, got him cleaned up and I was "carrying" this to the dirty utility for disposal when a doc just had to know "what I had". So I showed him. :)

Anyway, yes it is important. But, I avoid poo on the helo due to space constraints (no bathroom, beverage service or in-flight movies either!)

Have a great year!

Practice SAFE!

[Virgo_RN, BSN, RN]

Edited because I think these types of threads are divisive. I think we should work together, not point fingers. I apologize for any nonproductive or inflammatory comments I may have made.

[SuesquatchRN, BSN, RN]

The only time I find myself having ill thoughts about LTC nurses is when we get a patient who reeks of urine and has stage IV decubs on every single pressure point.

And that's how we always got them back from the hospital. Not that badly, but always with a new decub, usually sacral.

[leslie :-D]

incompetence pervades all specialties.

leslie

[NurseCherlove]

And that's how we always got them back from the hospital. Not that badly, but always with a new decub, usually sacral.

Always, Sue?

[txspadequeenRN, BSN, RN]

i cant speak for sue, but i can speak for my experience as a ltc nurse for many years...i say sue is just about on it. except my last two patients .one went out for chest pain and came back with a fx hip . the other went out labored breathing and came back with a broke arm...

always, sue?

[SuesquatchRN, BSN, RN]

Always, Sue?

Always. Really.

[NurseCherlove]

OK, why is this starting to feel like a hospital nurses vs. LTC nurses thing? Such was not the intent of my question to Sue - I just know how easy it can be to make blanket generalizations and try to avoid them if possible. But, hey, if the shoe fits....well, then of course say it. And if that particular shoe fits, then that makes me very sad.

I'll be honest though...I admit, I used to get quite mad when I would get a patient from a NH who was in for ARF secondary to dehydration. But then, when you really stop and look at all of the problems just recently mentioned, it truly is the SYSTEM we should be mad at!!! What acute care or LTC nurse is not completely worked to the max and then some!?!

I can't imagine having as many patients as the LTC nurses do! Let me also add that I always respected the fact that LTC nurses would always make it a point of asking about BMs when I would give them report. I noticed that pretty much, they all do it, which is impressive to me. There. Now that's what I call a pretty cool blanket generalization.