what can you say

Specialties Emergency

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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

Specializes in LTC,Hospice/palliative care,acute care.

i dont mind the pts.so much as the staff and the shouldnt be called "nursing " homes as very few even use RNs>>>>>I will not even respond to THIS remark here on this thread...........But-I will never understand how acute care facilities treat the elderly frail and demented...I have lost count of the number of my residents that have returned from the hospital with significant wt.loss(I am talking about the ones that were not NPO for some abdominal c/o) Pressure ulcers and diaper rashes galore and just plain smelly and dirty.....We know there are good and bad LTC's -also good and bad nurses and hospitals....I cannot understand why the elderly do not have a specailized unit in acute care as they have different needs then a middle aged or young adult...We have PEDS,NICU etc...why not units staffed with extra aides to deal with the non-skilled needs they may have-the self care deficits......I know what kind of info you need to care for a resident that is unable to speak for themselves and I send it and also call report.I also call the families and try to persuade them to meet their loved one at the ED-most can not be bothered....Other points I want to address....Often the staff docs make hours at odd times-it is not unusual to see a few roll in at 9 or 10 pm...that could be why you see an admission late at night that has been ill for days according to the paperwork--or the family initially wanted their loved one treated in the LTC and changed their mind....As for transportation-we contract with a private ambulance service for non-emergent cases-24/7.....As for increased confusion-many of us KNOW our residents well-just because someone had dementia does NOT mean that they can not convey distress in some way....It is easy to care for patients that can tell you where they hurt but for those that can't we are challenged to look for other clues....I work in a 250 bed facility -we have had 3 residents who developed pressure ulcers while in our facilty in the past 2 yrs......all 3 of them were very compromised to begin with (I am not excusing it-but 3 out of 250 in 2 yrs seems ok to me) We all know some lousy nurses and admittedly they are weeded out of acute care much faster then LTC...But please do not paint us all with the same brush-I have also had residents return from acute care clean with skin intact and looking good.......

We all have stories about the good and the bad. Let me add another stirrer to the the pot- NH family members.

We had a NH admit, a pt with urosepsis. She had been bedridden for a long while and incontinent of liquid stool x 1 month. Her daughter was telling me that she is going to sue the NH because they do not know how to clean a woman properly- from front to back and that is why her mother kept getting UTI's. I explain to her that diarrhea on a bedridden patient will find it's way to the urethra even with frequent and proper cleaning. The NH had done stool cultures and no c-diff or parasites and ova. Also this patient had intact skin. The cause was still unclear. But this lady was insisting that the NH was at fault.

Or what about when the family starts griping that the NH has made their 96 year old grandmother confused. "She was fine before she got there." Look in the H&P and see dx of dementia or alzheimers along with about 12 other medical dx's. Okay, sure.

I've been on both sides

please see:

https://allnurses.com/forums/showthread.php?postid=633879#post633879

sean

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
i dont mind the pts.so much as the staff and the shouldnt be called "nursing " homes as very few even use RNs
A person does not need the title of "RN" in order to provide competent nursing care. I know what is being implied, and it is disgusting. LPNs/LVNs are not merely "attendants" at nursing homes. I am employed at a nursing home, and I am certainly a nurse.

Although this thread is old, I felt obligated to respond.

Specializes in ER, ICU, L&D, OR.
A person does not need the title of "RN" in order to provide competent nursing care. I know what is being implied, and it is disgusting. LPNs/LVNs are not merely "attendants" at nursing homes. I am employed at a nursing home, and I am certainly a nurse.

Although this thread is old, I felt obligated to respond.

must be 5 to 6 yrs old, didnt even know they kept them that long

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
must be 5 to 6 yrs old, didnt even know they kept them that long
LOL :D ...Lots of threads get lost in Allnurses.com cyberspace.
Specializes in ER, Occupational Health, Cardiology.

In our area it was "get anybody that might require more than the basic attention out of the NH and into the ER for the weekend (or holiday.)" Several times the pts were evaluated and returned to their facility only to have them returned to us before our 12 hr shift was over!:smackingf

That not only PO'ed all of us, but the MDs were really gnashing their teeth, and the same EMS crews that transported them the first time were alternately resigned and resentful at being manipulated in such a way. It was from them that we learned that the staff was significantly reduced because of the weekend or holiday. One of our MDs even reported the abuse to Medicare, but nothing ever came of it.

Specializes in ER, ICU, L&D, OR.

Nursing homes are what they are. Cant really say much else

Specializes in ER, ICU, L&D, OR.

Nursing homes never change

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