I'm trying my best, but seriously stop putting me down on the phone

[Catch22Personified]

For other ED nurses out there, I don't mean any offense with this post. I'd rather vent here than take it out on someone who isn't even involved. I may have just bumped into a nurse with an awful day or something.

So I'm still in a LTC/SNF dealing with my patients at night we were overstaffed so we actually had a reduced patient load for once 29 instead of 38 to 40. I was so happy so I could catch up on paperwork. However about an hour and a half before my shift ends I have two patients acting up. Using ABC's I had to prioritize what patients had to be attended to first.

One is a patient with respiratory issues with audible crackles when breathing that basically with lower level of consciousness and lethargy. Pulse ox was 82 and even with the rebreather it did not improve so I arranged to get the patient sent out. I gave report to one of the ED nurses and she asked me what the blood sugar was. I said I didn't take a blood sugar because it didn't occur to me since the patient had audible crackles and a non improving pulse ox. She proceeds to go off on me: "It's standard procedure! Are you new or something? We'll be waiting for the patient"

The second one was complaining of chills and had a temp of 101.5, so I gave him the existing order of tylenol for fever orally and told him to call me if he feels worse. An hour later I took his temp and it went up to 103 so I paged the doctor. The doctor asked how his wound packing drainage looked like, I come to see the patient and I see the patient is in the bathroom looking as if trying to vomit. I tell the doctor about the new onset of nausea and attempted vomiting. Doctor orders to be sent to the ER. I have to call yet again to the ED for report. Sadly it's the same charge nurse I explain the situation and this time she decides to blast me again: "What is it with you people? Don't you understand oral tylenol won't work in older patients. Next time do a suppository first before calling, not even worth sending him at this point." *I explain the doctor ordered the patient being sent out* "You should have still done the suppository, still does not change things. You nursing home nurses are something else."

Seriously, I've been working for less than a year and these are the first two patients I ever had to send out. Was I in the wrong in my actions? I wanted to lash out at the nurse for being an ass but I was seriously too busy trying to help my patients out. Giving a suppository to a patient who is alert and oriented as well as able to swallow pills did not occur to me anyway.

If my patients don't get admitted, I'll be happy to take the writeup from administration for wasting time waking up doctors, clocking out 15 minutes late, and ******* of the ED at the affiliated hospital. I thought I made the right choice sending them out. But to be put down by another nurse, I can see why a lot of my classmates have switched careers already.

[CrunchRN, ADN, RN]

"the er is a way for docs to cya, and dependent on the ltc, fluids and iv antibiotics can be got at hospital. sure vicedrn, you'd want an admit to floor, but there are few docs that will make a trip to actually assess an ltc patient for floor admit. so, your beef needs to be between the er doc and pcps...

look in the end, an ltc nurse has to call for just about anything. who are we kidding here. ltc is not an old folks home. these nurses have to deal with 30-60 patients not just old people play'in cards. guess who is gonna get blamed for not catching something early enough."

i[color=#ff0000] think netglow really says it all with the above.

[Catch22Personified]

Wow, it's sad that you were treated so poorly. Good job focusing on what the actual problem was.

I don't want to be "that guy," but what was the flow rate for the O2 and was the bag on the nonrebreather inflated? That low of a sat on a nonrebreather is certainly an emergency that warrants aggressive intervention, which in a LTC place would include prompt transfer out.

I still feel stupid for forgetting SBAR and not doing the blood sugar.

You know thats actually funny you mention that, the first thing my supervisor said was: "Was the bag inflated before you called the MD?". But yes, in our case when the patient's condition does not improve after exhausting all options the supervisor calls the MD while the nurse is calling the medics.

I was off the past 3 days and asked what happened with the day nurse.

The pt with the fever was ended up having sepsis and was admitted. The 82 SPO2 patient came back with a diagonsis of AMS...but the next day got sent out for the same thing of a low SPO2 and got admitted for pneumonia.

[Nascar nurse, ASN, RN]

All of you asking me to be realistic are simply sugar coating what you are actually saying which is the MDs and RNs have the right to dump their patients on us and we should just be "more realistic" and shut up and take it. Well, kids, since these are my co-workers, let me assure you there are rowdy crowd unlikely to continuing accepting this kind of stuff.

I am an RN - in fact I'm the Director of Nursing at my facility...if I only had the power you insist I have.....

This topic is a shining example of how nurses repeatedly fail to try and understand each other and how we continue to rip each other apart. It's actually quite shameful for all of us.

[SHGR, MSN, RN, CNS]

ambgirl2nurse: it's protocol for the nurse to call ER and give report to ED (at least it has been at the 3 nursing homes that I have worked).

It's called "hand-off communication," lack of which is one of the biggest reasons for patient complications during any kind of transition. It's a huge push with my employer and I see a lot of it in the literature too (for instance that it reduces the 30-day readmission rate including to and from SNF's). So whether or not you see it as common courtesy or an annoyance, it is EBP and also part of meaningful use, ie money.

[SHGR, MSN, RN, CNS]

I am an RN - in fact I'm the Director of Nursing at my facility...if I only had the power you insist I have.....

This topic is a shining example of how nurses repeatedly fail to try and understand each other and how we continue to rip each other apart. It's actually quite shameful for all of us.

Well-said, Nascar Nurse. Like x 1000!!! We should all try working a shift in the other nurse's short-staffed and underfunded shoes.

[ClearBlueOctoberSky]

So whether or not you see it as common courtesy or an annoyance, it is EBP and also part of meaningful use, ie money.

Hello! New Nurse here. I honestly have no opinion one way or the other. If it needs to be done, it needs to be done, I understand that. I just wanted to know why it was done mostly. I have no experience yet, just received my license at the end of December, and am actively looking.

Like I said earlier, when I was a Paramedic I had always thought it silly considering the fact that I would be contacting the hospital as well, and I had no way of guaranteeing that I would be going to the same hospital that the sending nurse contacted.

I may ask a lot of questions that may seem silly, or that I should probably know, but without experience I don't. It's one of the ways that I learn. I am transitioning from one healthcare field to another where on the surface it may seem like they're similar, but in reality, they are no where near alike.

BTW, what does EBP mean?

[SHGR, MSN, RN, CNS]

Hello! New Nurse here. ...BTW, what does EBP mean?

I'm not sure if you thought I was being snotty (I wasn't trying to be).

EBP= evidence based practice, or research-based best practices.

An internet search of "handoff communication nursing" gives tons of information on it, and lots of reasons why the OP should have called the ER during this transfer situation, and why facilities have it as their policy and procedure.

[ClearBlueOctoberSky]

hey_suz

Sorry I took you the wrong way. I try not to make inferences, it's just been one of those days. Thanks for the information. I do appreciate it...any opportunity to learn. Hope you have a good night.

[Daisy_08, BSN, RN]

Hate to say it but it wont be the first b***h you will have the pleasure of dealing with. Learn to give it right back and then move on without another thought.I'm in Canada, never needed a doc to call 911 or had to give report to emerg, just the paramedics. Just seems strange to me.

[GGT1]

This is exactly why I left the ED. I loved the work...faced paced, always something new. But I could not take the cattiness and VERY STRONG personalities. I'm more of the shy-quiet type and it just didn't fit.

[TygRNoef]

The pt with the fever was ended up having sepsis and was admitted.

In your OP, when you said,

The second one was complaining of chills and had a temp of 101.5, so I gave him the existing order of tylenol for fever orally and told him to call me if he feels worse. An hour later I took his temp and it went up to 103 so I paged the doctor. The doctor asked how his wound packing drainage looked like, I come to see the patient and I see the patient is in the bathroom looking as if trying to vomit. I tell the doctor about the new onset of nausea and attempted vomiting. Doctor orders to be sent to the ER.

my first thought was SEPSIS. Reading this entire thread, I was wondering why nobody thought of this. Instead, people like VICEDRN are berating you because you wouldn't take your 2 year old child in for a fever of 101.5. I agree, I wouldn't bring my 2 year old in for a fever of 101.5 either, but your patient had a fever of 103, and a wound bad enough to require packing (a source of possible infection).

I'm thinking VICEDRN and the RN you called report to need to review their skills a bit. The symptoms of sepsis are: Fever above 101.3 F (38.5 C) or below 95 F (35 C), Heart rate higher than 90 beats a minute, Respiratory rate higher than 20 breaths a minute, Probable or confirmed infection. You didn't mention your patient's PR or RR, but everything else you mentioned pointed to sepsis. . .

My advice to you, blow off that ED RN, he/she was probably either having a bad day, or is a bad RN. You did what was right, and as much as ED RNs seem to like to think they're gods, they make mistakes too. I can't tell you how many times I have received a dialysis patient from the ED who is in acute CHF because the RN didn't inform the ordering MD of the patient's history when the MD ordered 4L of fluid run in wide open for possible dehydration due to a head cold or diarrhea.

[MKEdoc09]

Everyone is talking about reports being given between LTC and ER, or OP and ER, or vice versa, but something that I see being left out, is EMS. As a former medic (still licensed, but now working as an RN), I have an opinion that RN's, no matter where they work, seem to forget that they are transferring patient care to the EMS worker, and therefore, they should have a proper, timely report.

Also, do you find yourselves getting short with EMS? I found in my experience, that young Nurses were attentive, and listened to EMS reports, older RN's, nearing retirement would listen attentively to EMS reports, but that 30-45 year old RN, usually female (sorry, but I don't see the catty-ness from the male RNs that I do from the females), are often rude, angry, and interupt the EMS report, as a former EMS worker, it was very frustrating.