ER LPN forced to think another way

[libran1984, ASN, RN]

This week, I picked up a few shifts at an MRDD transitional care unit for PRN work with an agency. My normal position is a weekend option nurse at a level 3 ED.

I always knew from the beginning of nursing school I could never do LTC. It was a simple fact of life.

My first experience on the med cart with the paper MAR was riddled with errors. I kept seeing the dosage per pill but not the dose per administration.... Did that make sense? I was constantly harassed for going too slow; and I was completely clueless on how to deal with this constant need for PRN tylenol / Motrin with correct documentation.

The entire system was computer less... Like what the....?

One client, I swear, had a broken hand from hitting the wall in a fit of rage; two others were c/o chest pain which I assessed and ruled out as non cardiac thanks to past prison/ER experience. Mostly attention seeking.

Then during med pass I had only 15 ppl to pass meds to. Only 15. But I took almost an entire two full hours! I was yelled at repeatedly by both staff and clients alike for being too slow. During med pass I even broke a nail, completely uplifting it from the nail bed. I'm sure everyone knows how much that hurts!!! Like ow!!!!!!! Dang blister packs.

I was bleeding everywhere, trying to find a bandaid and pair of gloves without success.

Everyone was complaining, staff and clients alike, detailing all my faults and what not.

I was deep into freak out mode. ......... I digress.

Eventually, I came to a resting period where I was faced with a terrible dilemma; a client needed a follow up cxr post abx therapy for PNA but could only receive the CXR by means of ED. I actually started to argue with my DoN about sending the client to the ED bc he needed a cxr. Eventually, I understood that Medicaid would not pay for any other follow up exam unless it was an "emergency". Otherwise the facility would be forced to pick up the cxr bill.

We sent the client out and I felt like I betrayed my ER nursing peers, I felt like I let down all my LPN peers bc I couldn't sufficiently manage my paper MARS and i thought back to a time...

... A time when I was at the ER and took report from a LTC nurse- a pt had classic PE s/s but were not recognized for such- although they were recognized as "abnormal". Like duh. But when I explained the report to a fellow RN she said "you know why that is?" (suspect a PE) .... "it's because they're not real nurses". Even then I was so highly offended- it took me months to forgive that RN.

Seriously, LPNs have the short end of the stick. I truly believe acute care is so much easier than LTC. I have now successfully transfused FFP, assisted in multiple intubations, performed CPR, performed and interpreted ABGs, interpreted EKG rhythm strips, administered and initiated several kinds of IV therapy, and done ever kind of splint from volar, sugar tong, to thumb spica!

None of that was near as stressful as working my one day alone at LTC. Forget that craziness.

[Georgia peach RN]

I too have been an LPN working in acute care and worked a short time in LTC where I had 25 pts to pass meds to and half of them had a stomach virus then one I found in CHF who needed to go to the ER the other LPN working with me being kind enough to help me with all the paper work required for an ER visit filled it all out for me (our nursing home is attached to the hospital) when I arrived in the ER I was critiqued for the lay terms used on the paper work by the MD instead of listening to my report the RN taking report told this MD that I wasn't normally over in the NH but I was normally in the hospital ICU and M/S, he just decided he wasn't going to listen but did admit the pt with CHF which is what I told in report was my suspicion, that evening changed my view of the ladies and gentlemen who are dedicated to LTC, I make it a point to listen to them they know the Clint's like their family I never want to treat another nurse the way I was treated