Hi guys. Little background I am a novice nurse working in LTC. Been a medic since I was 21 and was also a pct since I was 18 so I am not "stupid" but sometimes I feel that way when I send PTs out to ER.
tonight I sent a pt with hx of HTN, and a-fib and a newly fractured femur to the ER. My reason, her HR was more thready and irregular than usual and her BP was 160/110. I didn't want her to have a stroke.. She's got the a-fib, fracture and high BP risking her for blood clots and stroke. So although her family was against it I sent her out. The ER nurse in report said, if she has a hist of a-fib then the irreg heart beat isn't so much of a concern. I said yes but I am more worried about her BP and risk for clots. She is on warfarin for the fib but still, better safe than sorry. Or am I wrong?
i send out people because I do not have the resources at my facility do treat people as an ER would but I only send them for really abnormal or major things..
im just trying to get oter people's input to see if I did the right thing or if I am being over-caughtous and dumping on the ER?
The only problem I have with your story is whether the family or patient consented first to the transfer. If they were against it and you talked them into, I would say good for you; however if they were against it and you called anyway then you have disregarded a fundamental patient right to choose.
As for the all the ED nurses saying that blood pressure doesn't concern them at all...I think you need to take a step back. I'm an ED nurse, and while I may not be terribly worried about her stroking out, it would at least raise an eyebrow. Especially in a patient who is (I'm assuming) on pain medication and without any complaints of pain or anxiety. She also stated the BP is typically in the 130/70 range...that's a significant difference. Sure, we wouldn't treat that BP alone, but I wouldn't ignore it either. To do so I think would just be negligent. I also want to add that if she is in fact on a bunch of pain medication for her recent femur fracture, then symptomatic pain could have been masked.
I try not to give our ALFs and SNFs a hard time when they send someone in. I may secretly be thinking all sorts of nasty things, but I'm also not in their shoes. And for all the times I've gotten a patient that should have come in days or weeks earlier, I try and appreciate when someone has taken the time to see something in a patient and get ahead of what's going on.
I talked them into it. Probably should have clarified. Anyways the good news is that this makes me wanna go back to school for RN and get into more acute care. I was talking with my coworkers and we all feel like we're running around and rushing through everything and losing good assessment skills. At the very least going back to school will help me brush up on my assessment
I don't know about this patient, but not every patient in LTC is incompetent. Sometimes the family may want one thing, but if the patient is competent, that's just too bad.
I think the OP did well under the difficult circumstances she was in. If I were a family member of a patient here, I'd be more upset about the lack of experienced personnel there. The OP is working hard, but she is really inexperienced. I wouldn't want her to learn on my family member, I'd want to know that she had a knowledgeable mentor on site at all times.
As an ER nurse, I'll tell you that we always grumble about transfers. That doesn't mean you shouldn't follow up on your instincts. If you are that worried, then send them!
I don't know about this patient, but not every patient in LTC is incompetent. Sometimes the family may want one thing, but if the patient is competent, that's just too bad.
I think the OP did well under the difficult circumstances she was in. If I were a family member of a patient here, I'd be more upset about the lack of experienced personnel there. The OP is working hard, but she is really inexperienced. I wouldn't want her to learn on my family member, I'd want to know that she had a knowledgeable mentor on site at all times.
I think the same thing and I'm not even putting myself down but I'm worn out and spread thin and always worried about my patients when I leave.
Insightful. I was wondering when someone else would realize I should get paid out the waz to sit on my duff and pin to my recipe board and do 0 patient care. It's the whole reason I busted my butt in nursing school. Finally someone recognized my true value.
I get that it's prob frustrating when you're sent a somewhat stable LTC patient. And I always thank the ER nurses when giving/getting report.. Even the ones who curse at me (yes that's happened lol)
Lupie, I don't mind taking care of anyone. It's difficult for us to discern just from a story what the patient really looked like...and if you had a feeling it's always better to act on it than regret it later. You did well. :)
The attitude from the previous comment that ED nurses don't want to take care of anyone...all I have to say is tell that to all my nightmarish memories of the trauma/code patients I tried to help and couldn't.
Specializes in CARDIAC,MED SURG, CLINIC, ER, AND SCHOOL.
I personally say you made the right call for your patient. I work in an acute rehab hospital that is about 15 min from our parent hospital. We are considered a 911 facility The mall has a better crash cart then we do. We do not have doctors present 24/7 like you we have NO resources I have sent plenty of unstable patients out and 99 % of the time I was correct. Most of the time the EMS treats us like we are morons and the ER well let's just put it we get the same from them too. You are never wrong to act for the best interest of your patient! I have developed a moto- when in doubt send them out to be checked out! Good call kid! Even if all is ok then wonderful but I would have done the same with over 20 years with most in an ER! Keep up the great work!
I personally say you made the right call for your patient. I work in an acute rehab hospital that is about 15 min from our parent hospital. We are considered a 911 facility The mall has a better crash cart then we do. We do not have doctors present 24/7 like you we have NO resources I have sent plenty of unstable patients out and 99 % of the time I was correct. Most of the time the EMS treats us like we are morons and the ER well let's just put it we get the same from them too. You are never wrong to act for the best interest of your patient! I have developed a moto- when in doubt send them out to be checked out! Good call kid! Even if all is ok then wonderful but I would have done the same with over 20 years with most in an ER! Keep up the great work!
Lupienurse, I think you did what was right. If in doubt send them out. I agree a BP like that and with her hx I would have done the same. You are a good nurse. I have seen a few of your posts and it is evidence you certainly are paying attention and care about your patients and that is what makes a good nurse. You will become more confident with experience. Don't be discouraged and become one of those grumpy nurses that just want to "get the job done". You exhibit what a nurse is meant to be a truly caring and compassionate person. Don't change just keep learning and you will be comfortable in your young profession in time.
In this situation, I would have sent the patient out also. I am an LPN with 20 years of experience. I have worked in an ALF where I was the only nurse on campus for 3 buildings. I only had med associates and personal care aides working with me who had very little training. ALFs all want to take more complex patients, but they do not want to provide the staffing to care for these patients. LupieNurse, you should not have to work as the only nurse in that facility. It sounds extremely unsafe. I have gone back to a skilled nursing facility where I feel that I have the resources to care for my patients properly. I felt foolish at times working in ALF when sending patients out to the ER that probably didn't need to go there. However, I did not even have an RN on call. An LPN was in charge as the Director of Wellness. We were required to send out all falls if they hit their head, because we weren't even supposed to be doing neuro checks. I did not have the resources to properly care for someone who needed complex care. I don't think I will ever work in an ALF again unless staffing and conditions improve. It was very unsafe for those frail elderly residents.
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I talked them into it. Probably should have clarified. Anyways the good news is that this makes me wanna go back to school for RN and get into more acute care. I was talking with my coworkers and we all feel like we're running around and rushing through everything and losing good assessment skills. At the very least going back to school will help me brush up on my assessment