LTC Rant - Call Freaking Report!

Kandis · Jan 10, 2004

I understand what you are saying. I work in LTC, which does give report to the hospital. I couldn't imagine it any other way. However, on the flip side, one complaint I have about a couple of the hopsitals around here is the resident gets sent back to the facility with skin breakdown that wasn't present when they left the LTC facility, and peri-care seems like it was never completed while at the hospital. Either the hospital is understaffed or the aides need better management. I thank the hopsital staff for saving a life, but come on, what's the deal with poor basic care? I want you to know it is not just LTC that does these kind of things. Kandis, BSN

TracyB,RN, RN · Jan 10, 2004

God, I hope this doesn't turn into one of these Them Vs. Us arguements.

There are good hospitals, there are bad hospitals. There are good LTC & there are bad. . . We all work in healthcare, we all have bad days, & yes, unfortunately patients in both settings get neglected. How you choose to react to that unkempt patient may or may not make a difference. Are you writing to your Senators & the higher powers that be, to urge reform for issues like staffing, overtime pay, medicare/medicaid reimbursements rates? Are you reporting abuse & neglect issues through the proper channels?

I am tired of the it's them against us fight. It will never go away, until all nurses band together for the sake of each other, our patients, safe staffing, and fair pay for what we do.

Tweety, BSN, RN · Jan 10, 2004

Sounds more like a vent than a us vs. them. It would be very unacceptable to have a patient show up and not have any report.

In this area it is the LTC facility that calls us for a nurse-to-nurse prior to accepting a patient, because we are at their mercy when they are ready to take the patient. They know they are getting the patient and they call for report. Often they get a nurse-to-nurse long before the patient is officially discharged.

Most of the calls I get from LTC's are when we forget to include proper orders or med sheets.

Kandis, I understand what you're saying.

Tim-GNP · Jan 11, 2004

I agree with TracyB--- I also see Brandys point. I guess working in both LTC and acute care, I have seen both sides.

I have sent resident's to hospitals with fully intact skin and received them back with stage III pressure sores, and significant weight losses. I can also recall several times that I had called report to the receiving hospital and the ER nurse gave me the 'they're old... just let them die... why are you wasting my time?!!" attitude.

I have also sent capable residents to hospitals who suffered an 'acute confusional episode' in the nursing home--- who, before they were confused would consistently refuse to allow nursing care, now that they are confused, they appear at the hospital looking all nice & neglected. I recall one resident who refused a shower for over 90 days. Nothing worked to get this lady into the shower. She was 100% capable, and perfectly with it. Try to force her and in the long term care facilities [due to our wonderful regulations], you are guilty of "Resident Abuse" or assault and battery.

There are some nursing homes out there that are just pig styes. They shouldn't be allowed to take care of house plants, let alone human beings.

I guess I have no good answer to this one, except, try to communicate. Remember, when you take report from a nursing home nurse, that they are not in the same mode of thought as you are... the focus of the nursing care provided in nursing homes is dramatically different from the hospital.

I hope this helps, but something tells me it doesn't.

Cheers!

BrandyBSN · Jan 11, 2004

i understand... and this was definately not an "us vs them" type of post...

Everyone is understaffed, basic care can be neglected by any facility, either due to lack of effort, or lack of staffing.

Our hospital takes anyone and everyone because we are the only hospital around and can not really go on diversion.

Send the ERs whatever patients you and the doctor believe needs to be sent to the ER...its my job to take them and take care of them.

just please give us a heads up and let us know what is on the way :) A verbal report with ability for questioning and feedback is much better than papers (or lack of papers) alone. Dumping a patient on our doorsteps is just not right.

Thanks for letting me vent

BrandyBSN

LPNtoBSNstudent, BSN, RN · Jan 11, 2004

I am guilty of this!! A few weeks ago, I walked in for my shift a little early, and in the middle of a medical crisis for a particular resident. I hadn't gotten a chance to even clock in yet, and I just put my coat and purse in a corner of the nurses station. Anyway, the charge nurse on duty wasn't real sure of how to handle this particular situation (plus she needed to handle another situation on the other side of the building), so I assessed the resident, got vital signs, called the doctor, filled out the transfer sheet, called the ambulance and gave them report, then I called the family to let them know, then I called the DON and administrator. By the time I got all the copies made of the MARs, advanced directives and packaged them all up neatly in with the transfer sheet, the ambulance personel were there and wanting me down in the room. So then I gave them a face to face verbal report and then the family rushes in and I give them another verbal report. ANYWAY, I TOTALLY FORGOT TO CALL THE ER!! I didn't even think about it until I got the call from them. After the resident/family members/EMTs left the facility, I started doing a lengthy documentation, then (Oh, yeah, I better clock in, get report on the rest of the building..and count the narcs). Then I just went about my busy day like nothing happened...until I got the call from an ER nurse. HE WAS TOTALLY TICKED OFF. He was angry that I didn't call. He told me about how crappy care we give and that this same thing happened last week, etc, etc, etc. I felt terrible, the only thing I could do was to apologize. I knew I was supposed to call them, it just slipped my mind. BTW, we give great care, but I can see how he would be mad about the situation. :)

mattsmom81 · Jan 11, 2004

This definitely goes both ways. I have worked agency at a rehab facility and received patients still not completely out of a CHF crisis, really not ready for discharge IMHO and no report from the hospital nurse. Granted somebody accepted this patient (ie the problem is bigger than the nurses)

As a critical care nurse I know the hospital probably had 10 patients holding in ER waiting for this lady's bed...and she was probably the healthiest thus first one to get shuffled out the door. The transfering nurse probably had several patients rolling down her hall as my lady was being transferred, with ER pushing to give report before the lady's room was even clean (and the nurse had to clean it cuz housekeepers were tied up with stats in OB and ER).

Let's all try to see the big picture here and not blame nurses for all the problems out there in today's poorly run/staffed facilities.

If a nurse doesn't have time to call me report I try to understand as I've definitely been there. Yeah it's a nice courtesy but I get direct admits quite often from other facilities, and we just do the best we can. That's all we can do some days.

ktwlpn, LPN · Jan 11, 2004

The bottom line-nursing is difficult enough without our fellow nurses doing things to make it harder......(inadvertently or not) LTC and acute care is like apples vs.oranges....Both areas are very challenging and unless you have worked both you really have NO IDEA..... I transferred an end stage alzheimer's to the ed a few months ago to have his hand and arm assessed due to swelling......He had his days and nights turned around for a few years .His elderly wife had been caring for him at home but sheltering the adult children from the truth of their dad's condition and they were difficult to deal with...and I suspect(no,i am convinced) that she was more then a little forgetful....At the home he never even flinched during his QID fingersticks with insulin coverage or his lab draws...He seldom reacted to deep painful stimuli when he was asleep...End stage Alzheimer's patients usually react differently to pain.....This man had been beating the crap out of my staff since day one and our psych doc was working with him....The family freaked out because they were unaware of some of the med changes (the mother had been notified and that was well documented) They pitched a booger in the ED and the man was fully worked up-CAT of the head-chest Xray-labs and straight cathed.....All negative - back he came....a few days later he spiked a temp-back to the hospital he went-He died several days later fron urosepsis......Thanks to the straight cathing in the ED....Remember-he went out due to persistent swelling of a hand and forearm-that x-ray was negative.The ED nurse whose lack of knowledge regarding dementia residents caused this family heartache and was the major contributing factor to this patient becoming uroseptic and dying-I spoke with this nurse several times and attempted to explain this residents situation to no evail....His prejudices against nurses in LTC made him incapable of learning from me...Fortunatly there was an MD in the family-when he came to town and reviewed his father's records he came to the same conclusion and he is responsible for diffusing a nasty situation....We need to learn from each other..

FranEMTnurse, CNA, LPN, EMT-I · Jan 12, 2004

Since I live alone, and have had several near death experiences, I have been told by both the hospital staff and my home healthcare nurse, that I may need to be placed in a nursing home.

The very thought of that scared me to bits and pieces! I have worked in LTC facilities as well, and see how depressed those poor residents are. I truly feel bad for them. So for now at least, I am thankfully at home with a long term CNA service and homemaking service.

I used to be an activities director for one LTC facility, and created a men's club, decorated the place for Christmas, put on performances for them, and published a paper titled, "The Gay Nineties Review," that I personally wrote a poem about residents, targeting what they are noted for. They all loved it, and I was even given a homemade jewelry box that I treasured for several years.

And BrandyBSN, We do appreciate your work here. At least I do, and I think others do also. Hang in there girl, and hang on we need you.:kiss

Fran:nurse:

**canoehead, BSN, RN** · Jan 12, 2004

ktwlpn,

I don't get what the er nurse did wrong either- can you explain?

hogan4736, BSN, RN · Jan 12, 2004

Originally posted by LPNtoBSNstudent
...I am guilty of this!! so I assessed the resident, got vital signs, called the doctor, filled out the transfer sheet, called the ambulance and gave them report, then I called the family to let them know, then I called the DON and administrator. By the time I got all the copies made of the MARs, advanced directives and packaged them all up neatly in with the transfer sheet, the ambulance personel were there and wanting me down in the room. So then I gave them a face to face verbal report and then the family rushes in and I give them another verbal report. ANYWAY, I TOTALLY FORGOT TO CALL THE ER!! ... :)

no offense, I have made the same sequence mistake...I have found a better sequence for non-911 patients:

1) assess pt

2) decide to send/not send

3) call family

4) call doc/np

5) call transport

6) make copies

7) give report to transport

8) ALWAYS, ALWAYS, ALWAYS call the ER (while patient is still being loaded into ambo at your facility)

9) no need to call DON unless she is soooooooo anal that she needs to know NOW!!!!!!!!!

Leave her a voice mail in her office.

For 911 patients:

1) assess pt

2) call 911 at bedside

3) have someone else get facesheet, MAR and H&P copies

4) give report to FD

5) call the ER

6) call the family

7) fax anything you forgot to the ER

8) call doc/np

I have done ER (8 years, hated many LTC nurses for not calling), and LTC (7 months, life on the other side is just as hard)

sean