what can you say

[teeituptom]

Howdy yall

from deep in the heat of texas

I will never understand nursing homes or nursing home nurses. After another lovely weekend with sick people, trauma of all sorts. psych patients and the usual ER stuff. At 0200 hrs a nursing home nurse sends you a patient who fell several days ago.they got an xray, and early saturday morning they send that pt to you with a fractured hip, that no ortho doc is gonna touch as the patient is completely bed ridden, so after examining the pt and doing all the usual workup, you send her back to the nursing home with pain meds. And then the nursing home nurse calls and demands to know why you havent rushed the patient to the OR.

Then another nursing home sends you in a CPR in progress, of an elderly patient with marked lividity and rigor. After you pronounce and notify their family and the family yells at you because they had a advanced directive prohibiting resuscitation. Of course that was on file at a the nsg home, we have no copy and the paramedics werent made aware of it.. Then the family yells at you even more because of you telling them they need to come in and do some of the post mortem paperwork. I dont know what to think of this.

Then another nursing home calls EMS to transport a patient who is seizing to you. You get the patient you take a rectal temp, and the temp exceeds what the IVAC thermometer will measure. No wonder she is seizing. The patient does not make it. You call the nursing home and ask what has been happening with the patient, they tell you shes been ill for a couple of days. You ask when she was last given tylenol, they respond yesterday morning. Then they say we didnt want to mask any signs or symptoms that might be important to you..... How can you tactfully respond to them......

Then there is the one who pulled or had pulled their PEG tube out and they send him over to you. Thats not a problem you slip in a foley and secure it and send them back, as the ER docs arent and the GI docs arent going to replace a PEG in the middle of the night. You send the patient back and again the nursing home nurse calls and yells at you again for not putting that PEG tube in that they wanted.

I dont know about yall but I tend to cringe when the secretary calls and says there is a nursing home that wants to give us a patient report... I know there are good nursing homes and good nursing home nurse out there somewhere. but I havent been running across any of late while working...

Sorry yall. It aint like me to vent to often, but when I do.

meanwhile

doo wah ditty

[CATHYW]

Tom, I felt the same cringe when I worked ER, and recieved these patients with urine soaked sheets that had dried and been resoaked, and peas and corn under their breasts. Yeeeuuucchh!

On the other hand, I was always overjoyed to call report BACK to the ECF. Several times I was greeted with, "but I was told they would be admitted!" Turns out the nurse that sent them to the ER told that to the oncoming shift, not the Dr.! We do have one ECF in our area that is fabulous, and like Shygirl's has a 2 year waiting list. A person could die, waiting to get decent care!

[RainbowSkye]

I know. I wonder what the answer to this is. I know the nursing home staff are overworked and underpaid, but.... A couple of weeks ago I had a gentleman come to our ER from the local long term facility. I was told in report (these nurses always do call, well almost always) that he had cut his hand during a visit to the doc earlier that day. Come to find out this nurse call 911 for a wound she had never looked at (the folks who transported him to the doc's office bandaged him). The laceration turns out to be an itty-bitty skin tear. Now there's no way to get him back to "the home". Which is okay because the man is febrile, stinks to high heaven of nasty urine (which turns out to be solid green when I cath him). So he gets admitted for uroseptis. Makes us nurses look bad.

Do any of you nurses who work in long term care have any suggestions?

[JE1RN]

I WORK IN THE ER BUT IF THAT WAS THE CASE I WOULD HAVE NO PROBLEM CALLING THE HEALTH PROXY AND THE STATE HEALTH DEPT.AS FAR AS THE USE UF UNDER PAID AND OVERWORKED THAT GOES FOR ALL OF US

[Coldfoot]

...they are just as helpful to the Medics when they pick'm up at the Home. Try to be understanding when the Medics can't answer those silly questions like "How long has he been like this?" or "If this is confussed then what is baseline?" Just gotta throw out a couple experiances.......IM D50.......Call for ALOC, arrive to find a HUGE PULSATING MASS IN THE ABD with bp of 80/60....... IV Start for dehydration sec. to overdose on Lasix..... Gotta drive you nuts sometimes

[flashpoint]

LOL...We see stuff like this all the time. I work ER and I'm a volunteer paramedic, so I tend to catch it from both ends. I just love it when we show up at the NH and the nurses yell at us for opening up the transfer packet..."That's confidential....that's for the ER, not for you!" Well, if you want this lady to get into my truck, you'd better give me a little history. We have one NH that sends us patients for enemas all the time. The best (worst) was when I was in paramedic school. Picked up a lady at the NH for "severe respiratory distress." We show up and the lady is there in bed, flat on her back, and mouth breathing - her tounge was STUCK (tight) to the roof of her mouth. Her sat was 76% and her resps soundsed like STRIDOR! My preceptor rolled up the HOB, I did a little oral care with those little pink sponges and got her tongue loose...and what do you know? Her sat came up to 99% on room air and her "stridor" went away.

[Indiana ED RN]

Originally posted by traumarns

BUT ALAS, no phone number, address, or name of the ltcf on the face sheet. just the pts information, diagnosis, religion, core status....

Hello All

I must agree with the above comment... but I find something even more amazing. The many times I have had a patient come in that is altered and the paperwork states he is DNR. Fine and Dandy if the patient could tell me his name....because there is not an armband to be seen. My newest trick for this is to have someone come from the nursing home to verify who the patient is and have them place an armband on their patient!

Me

[Kayzee]

Been reading your posts, and hope you realize that there are good LTC facilities. I work at one, and these people get the best of care. I realize there are many bad ones out there, and I wish something could be done to close them. I'm shocked at some of the care and conditions of these facilities. When we send out a resident, info is definetly sent with. Too many of our fragile elderly are not monitored or given the care they desrve.

[tatianamik]

Originally posted by teeituptom

I will never understand nursing homes or nursing home nurses.

I had one refuse report on a patient that we were returning. NH stated mental status changes (told paramedics that they had arrainged a direct admit to the psych floor as she had a psych history, but that was not done). All our Doc could find was a UTI. They refused to accept the patient back. We went so far as to call the administrator of the nursing home at thier house at 3am. The administrator refused to accept the patient back. Licenseing board was getting a phone call the next morning...

[RNFROG3, BSN, RN]

i like the one where the NH across the street from the hospital calls 911, calls report to the ER for resp distress or code in progress and then the paramedics call us back asking us to call the NH to let them in. They are LOCKED OUT!!!

[AngelGirl]

I worked in a Nursing Home briefly years ago. An aide came to find me to report that a patient had no pulse. I checked the DNR status report first. The patient was a 'No Code.' The aide accompanied me down the hall, explaining that the patient WAS still breathing, but had no pulse. Huh? I'd loved to have seen her CPR exam! Scary.

[Chiaramonte]

I am enjoying the scenerios here!! Amazing that there is a commonality of complaints. I also work in the ER at night and have never gotten report from any of the 3 Nursing Homes here before they send their patients in. But on the other hand, try to get these people transported back...takes many phone calls...should be their problem...not ours.

I always feel so frustrated when they come in gurgling and need suctioning from the aspiration pneumonia they've recently acquired from being fed through their peg tube and laid flat afterwards.

I know there are exceptions to the rule and there are good nurses working in most of the homes but it's just those few that ruin it for everyone...

[berry]

my fav is to ask the nurse calling you report on a pt the are sending over for resp distress and you ask for v/s you get the long pause then a hold ...........wtf i always ask 9/10 times they dont know course no big deal as you will get an ems report in route and actually find out what is going on with the pt. My biggest pet peeve is pt in arrest situations with no lines damn NH have RNs i am sure of it how can you send a pt with no line i know you had time between finding them and ems arriving, and howbout switching form 2lnc to a nrb for pts with sats in the 70's