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.

[Agnus]

I agree that not enough attention is paid to bowel care in the acute setting. As a nurse I have only worked acute. As I CNA I worked LTC.

Many years ago my grandmother died in the acute hospital because they ignored her pleas and our family's to address the fact she had not had a BM.

Autopsy revealed that a fecal impaction was so large and so hard had cut circulation on a major vessel and caused death.

I am not having a good day unless my patients are peeing and pooping. Not everyone feels that way. Most nurses I have met have an aversion to checking for an impaction let alone removing one.

If we keep on top of it we can usually head off problems before the pt becomes impacted.

This is pure neglagence. At out hospital in our community the LTCs will not accept a pt without a documented BM in the last 3 days. The hosp knows this so even if nurses don't keep on top of it the doctor makes sure measures are taken if necessary to correct the problem prior to writing the discharge to LTC order.

There is more to keeping a patient alive than "keeping him breathing. So you kept him breathing while he was there but he was miserable because you could not be bothered to address his other physiologic needs?! Or worse he died because you were and idiot. Too bad autopsies are not done regularly any more.

[Agnus]

incompetence pervades all specialties.

leslie

As does out right neglect

[husker_rn, RN]

I am an LTC nurse who has seen both sides of the story....I just went back after 4 years of med-surg. Hospital nurses are so overwhelmed that the focus often tends to be the admitting problem; other areas get overlooked. As an LTC nurse I become angry when I send a frail elder to the hospital and he/she comes back with decubs that take forever to heal. But then I remember the nights of 11-12 patients and 1 CNA and understand. I have seen hospital nurses who look down on LTCers. I point out they focus on one problem and I look at multisystem failure many times a day. It's a tough job no matter the specialty.