ilovewoundcare

I check the objective stuff first before jumping to conclusions. VS, EKG, video camera feeds, what have you. For seizure-like activity, we have standing orders to draw prolactin and dilantin levels asap. Here's a trick for producing voluntary movements during a "seizure"- petting the patient's eyelashes. If objective data is not consistent with the subjective data I still pretend like I believe the patient. I ask them what would help with their problem. Then I give them something they didn't want, but isn't technically wrong. "Abdominal pain? Nausea, vomiting, diarrhea? Wow, that's a lot. What do you think would help?" "Gatorade would be nice. Oh, and I work in the kitchen. I probably shouldn't be working around food. Can I have a sick slip for a few days?" "Medical doesn't give out Gatorade. As for the sick slip, don't worry, I won't isolate you! Actually, so long as you wash your hands really well after you use the bathroom you shouldn't be a danger. Here, come to the sink. I'll show you hand hygiene. You have to get around the fingernails and wrist- that's where people usually forget. Now I'll have you demonstrate- there's an easy way to remember how long to wash your hands, too. Sing "Happy Birthday" two full times. I'll even sing it with you." They come for the sick slips, the restrictions, the meds, etc. Then they leave feeling silly and unsatisfied, but they rarely display anger because I acted like I took them seriously and cared about their "health condition." No one ever accused me of not educating my patients! It's such a fun game when you realize how to play it.

I think I understand what you're saying, though an LTC facility is a care facility whereas this place isn't. The person who had some event occur isn't a patient. They are just a person at a non-medical building within walking distance of the medical building. An RN hasn't done an assessment on the person first. No one has assigned or delegated the patient to the LPN after assessing the stability of the patient and the predictability of the patient's outcome. That's why the RN is supposed to take over the patient after the patient arrives- to do a full assessment and determine the patient's stability, take steps for further referral, etc.

It's not an LTC... It's more like... a campus... with a sick bay... I don't want to be too specific. There's usually an RN and an LPN on duty at night. The RN is supposed to take care of the unstable patients. The LPN takes care of med pass and stable patients. The controversy is who leaves when there's unstable people who need brought in.

There is a bit of controversy at my workplace currently over an LPN's scope of practice. Our boss is requiring the LPNs to go to people who have passed out, had a seizure, got a head injury, etc. The LPN is then supposed to bring the patient back to the building in which the RN works and transfer care to the RN. Our boss says all the LPNs have first aid training, so it is within their scope. The LPNs disagree, stating that this counts as an initial assessment on an unstable patient. Does anyone have any insight? Has anyone encountered a similar issue? What are your experiences?