Er pusher

I just don’t think you can be too careful in this

Usually you'll need to have a doctor's order in a nursing home to send a patient in. Some common reasons are a change in condition, alteration in vital signs, post accident (Falls, trauma of other types), uncontrolled bleeding, difficulty in breathing, chest pain unrelieved by medication, etc. Elderly patients can often have subtle less obvious changes, such as a change in level of consciousness, increased confusion, or restlessness, that can indicate problems which need further evaluation. Something like a UTI can lead to sepsis faster in an elderly patient but with signs that might be attributed to something else.

One of the best things about being a nurse in a nursing home is that one knows the patients well. As a former ER nurse, I'd trust this nurse's intuition. If something seems off, follow up on it. Watch them for those subtle things that can mean a higher level of care is needed.

You'll know. It's instinct. You'll know when to send them. If it's urgent enough you send them, then get the doctor's order. But trust yourself!