I've been at an LTC facility for 3 months now. One thing is clear at my facility: take caution before sending residents out to the hospital. I was always taught as far as LTC goes, especially as a newer nurse, "when in doubt, send them out." At my facility, the DON seems to be overly concerned with the # of Medicare patients and how it affects the total reimbursement from Medicare, i.e. $$$, folks.
Anywho, I had a 65 yo resident with hx of cva, afib, dvt, esrd and hypertension. Due to the cva, she has dysphasia and can't communicate well. It's apparent to everyone that she's "with it" and understand's what's going on around her but her speech is distorted. She's usually always "talking" though. This morning at 0500, in the middle of my medpass, the CNA's grab me and tell me she's lethargic and not responding as usual. I go in and sure enough she's very lethargic and not responding verbally at all. She's able to follow my commands and squeeze my hands, but very weakly. She couldn't lift her arms at all. Her eyes occasionally rolled in the back of her head and she couldn't keep them open for long. She had a fixed stare at times, so I thought maybe she was having a cva. Her skin was cold. Her bp was 139/77, when her SBP is usually 80-100. Her o2 sat was 82%. I put her on 2L. Her bs was 114, no hx of DM. After I put her on 2l, I wasn't able to get a pulse ox reading.
I grabbed the other nurse who was working and has years of experience and she agreed that she didn't look well.
I sent her out and 20 mins later the ER Nurse calls me with an attitude saying she's treated this patient 3x before and this is her baseline. I calmly told her she's been a patient of mine for 3 months and this is definitely not her baseline. The woman argued with me that because of her hx of cva she is completely nonverbal and doesn't speak. I explained to her she does speak, although incomprehensibly...
The patient was admitted for urosepsis.
My DON said I did a good job assessing, but why didn't I think of giving her a nebulizer treatment? To my knowledge, the resident has never had respiratory issues. She basically told me I should've done more to try and keep the resident there because it looks bad when the hospital is audited by Medicare for readmissions.
I just leave work sometimes feeling horrible. I try to put my patients first and care for them as I would my family. I don't have all the insight and years of critical care experience that my DON has. If that was my grandmother lying in the bed, I would definitely call 911 after doing all I knew to do and still feeling something wasn't right. We're not even able to call the doctor at night, we text him. And it usually takes him eons to respond back. The DON almost expects perfection. If something would have happened to the resident, I would've been blamed. Can't win for trying at this place! I managed to get all of my paperwork done, call the family, finish my med pass, medicate a seizing patient and deal with some low blood sugars and all she could point out were the things I missed this morning!!
