%D#2 298 Posts Feb 11, 2016 "Idk this isn't the place for me and im looking for other jobs and going back to school." And all the while, the resident has not received treatment.I understand why you're interpreting this that way but I care a lot about my residents. she did recieve tx the minute I got back after my time off. i checked her and sent her out to the ER. Can't blame me for being frustrated at this job. Nothing is all about me, but one should like their job and not just say, "im gonna put up with this because it's all about my residents" It's all about my residents/patients when I'm At work.
%D#2 298 Posts Feb 11, 2016 In my area they send residents from AL out to the ER all the time to get evaluated for "altered mental status" or "fever" when the patient does not have a PCP who is doing home visits or has a NP who does home visits. It really depends a lot on the residents insurance and provider. Some health care providers who are part of medicare advantage plans are sending out their NP to see the patient in their home - home can be an AL facility.But if this is not the case, and the patient needs to be evaluated, they are being send to the ER - which is a long wait, not cost effective in most cases, and a lot of aggravation for most.That's why I initially wanted to cath her but they d/c'd the UA and the cath, and by the time I came back for my scheduled day to work she was not in good shape. But she's on IV ABT now and doing better
%D#2 298 Posts Feb 11, 2016 Updates, patient is doing well. :) she had large Amt of e. Coli in urine and has UTI but no kidney infection or sepsis! Also- Regional director is fumed that they dc'd everything and I said, in all due respect I've heard a lot about AL being cited for doing invasive procedures so maybe from now on we should just make arrangements to take her to urgent care or just send to ER. She said that's not the protocol and that if it's emergent that I need to do certain things under certain circumstances. So I said, "I understand, but in order to do this the right way can you please sign off on these things as I am very cautious of doing them in AL but if you sign off that you approved the skilled care in these situation I will gladly do it. She said that's fine. I'm holding her to that.Thank you all for the input!
NutmeggeRN, BSN 8 Articles; 4,584 Posts Specializes in kids. Has 40 years experience. Feb 11, 2016 Updates, patient is doing well. :) she had large Amt of e. Coli in urine and has UTI but no kidney infection or sepsis! Also- Regional director is fumed that they dc'd everything and I said, in all due respect I've heard a lot about AL being cited for doing invasive procedures so maybe from now on we should just make arrangements to take her to urgent care or just send to ER. She said that's not the protocol and that if it's emergent that I need to do certain things under certain circumstances. So I said, "I understand, but in order to do this the right way can you please sign off on these things as I am very cautious of doing them in AL but if you sign off that you approved the skilled care in these situation I will gladly do it. She said that's fine. I'm holding her to that.Thank you all for the input!Glad the pt is doing well, but I would still be leery of working outside the scope of AL license. Get the regs or call your BON, they will be able to help.
allnurses Guide hppygr8ful, ASN, RN, EMT-I 4 Articles; 4,721 Posts Specializes in Psych, Addictions, SOL (Student of Life). Has 21 years experience. Feb 11, 2016 Many nursing homes and AL's don't want to send residents out to ER especially if it's within 90 days of last time out as medi care won't pay for the readmission and the sending facility eats the costs so they try to treat them in- house. In our facility we have a standing protocol for obtaining a straight cath as many of our patients simply can't supply a clean catch sample. We've gotten pretty good at swooping in and getting the sample quickly and without undue drama or trauma.Hppy
SquishyRN, BSN, RN 518 Posts Specializes in ER, Trauma, Med-Surg/Tele, LTC. Has 13 years experience. Feb 12, 2016 It's pretty incredulous how nothing was done for this patient in the 3 days OP was off work. OP was still the one who ended up sending this patient out. 3 days with no urine collected, no antibiotics, no interventions whatsoever for a patient that was exhibiting altered mental status for some time already at this point. It's pretty sad how apathetic some people can be even when lives are concerned. OP, based on this post and several of your other posts, even though you're new and inexperienced, I think you're already a GREAT nurse. Your actions stem from patient advocacy instead of just blindly following rules. I'm sorry this particular place is burning you out already.
ProgressiveActivist, BSN, RN 670 Posts Specializes in ICU. Has 20 years experience. Feb 12, 2016 It was an eye opener. I have a better understanding of why so many Assisted Living residents present with septic shock.
%D#2 298 Posts Feb 13, 2016 It was an eye opener. I have a better understanding of why so many Assisted Living residents present with septic shock.My guess is the UTI issues as well as infected wounds. I'm really on top of dressings.. I'm always working closely with wound care nurses and keeping them updated and if a wound is not healing properly I call them right away to get the resident on the service
Libby1987 3,726 Posts Feb 13, 2016 Our local ALF's take their patients to out patient services, she could have been seen as an out patient for a cath UA without getting to the point of needing ER and IV abx. There's definitely something wrong with your employer's protocols and/or training. I wouldn't consider that $5000/mo care.
NurseSpeedy, ADN, LPN, RN 1,599 Posts Has 21 years experience. Feb 17, 2016 I haven't read all of the posts yet, but having worked in an ALF in the past I know that a lot of what the facilities nursing staff is allowed to do is based on the specific licensure of the facility. I worked for a very large facility but we did not have the licensure to do anything 'skilled'-not even a bandaid with neosporin-had to have a home health order-seriously...it's frustrating, but the facility may not be able to straight catch in the ALF section of the facility.
