"Don't Send Anyone Out!"

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I'm a newer LVN and employed as a weekend-double shift nurse at an upscale nursing home. My weekend RN supervisor has a happy-go-lucky, coolly unconcerned personality. He unrelentlessly picks on some nurses but tends to leave me alone.

He has made it crystal clear that we are to refrain from sending any resident to the hospital unless they are extremely ill. His reasoning is monetary: if a resident spends one week in the hospital being evaluated and treated, then the nursing home will lose one week's worth of money from that resident. Private-room residents pay $6,900 monthly and semi-private residents pay $4,600 monthly. This seems fishy and unethical to me. I usually will send a sick resident out because I want no person to die or worsen under my care. Any thoughts or comments on this issue?

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Good post- I would not call it "bad nursing" It is just the nature of LTC.
Thanks for understanding.
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Specializes in ICU, PICC Nurse, Nursing Supervisor.

No nurse in her right mind would accept the care of an additional 20-30 patients.. Thats crazy!!! If a nursing home resident has a sudden change in condition of this nature... they go out, period. Nursing homes are not acute care facilities and the lab and x-ray services in his area are just about useless.. We are talking 4-5 hours for a stat lab IF YOUR LUCKY!!!! The doctor is not going to see this patient in the nursing home unless the doc is in the home to begin with. They rarley make the special trip because they cant do anything, but send them to the hospital. There is nothing for the RN to exhaust this man had a bladder surgery three days prior ,now has a change in LOC and V/S dropping. Nursing home admin is only worried about losing money , a patient could have a MI and they would want to know why we sent them out ..and then when are they coming back! What the board of nursing would not accept is why this nurse let this man stay in a bed with a noticable change in condition and tried to care for him when he obviously needed quicker and more acute care.

Having 20 or 30 other patients is not an adequate excuse. I doubt that the board of nursing would accept it either. The care of those 20 or 30 patients can be delegated to another nurse. Priority of care is at question then. A LTC facility as part of it's license to operate is supposed to have access to services like lab and IV access. Pharmacy services usually have an IV nurse oncall for placing IVs. Labs services are also supposed to have stat lab service. So, I'm not buying that reasoning. If you don't think your facility has these services, you all need to have a sit down with your leaders and discuss these things. Now, if you can't relieve a distended bladder and pass a catheter, that is a situation that requires action and a transfer out. But, I will still stand by what I said. A licensed RN should exhaust all avenues of care that can be given before turfing the patient off. That is part of the responsibility of being a charge nurse.
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Mean? Mean towards who? You must have called 911 during their dinner break....And who are they going to file this complaint with? Your employer? The BON? What crap...How many times have paramedics shown up at the LTC and b*tched about picking up the resident? How old is she/he? Well-is she/he a dnr? Why are you sending she/he out? Often times spoken right in front of the resident..... Cut me a break-looking at his vitals he at least needed his tank topped off and maybe a cysto..I wonder what his hgb was...I bet he was dehydrated,too.........Let us know what happened.....

there is rarely a need to call 911 from a SNF to send out a pt...911 is abused by MANY SNF staff...The situation did not warrant a 911 call, rather a PRIVATE ambo ride...

Nursing staff calling 911 too much, is my problem w/ SNFs sending pts to the ER...I was a w/e supervisor in a large SNF...In 2 years I called 911 TWICE (respiratory arrest, status epilepticus)...And we sent out patients semi-regularly

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I am sure you've already made up your mind on what to do however I work in an ALF and the term that was given to me by my supervisor is "When in doubt, send them out." Her reasoning was we do not want people that aren't under hospice care to die in the building. So send them out. Just use your best judgement and whoever this boob is can stuff it.

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Specializes in Critical Care.

Being a good nurse is not always the same thing as being a good employee.

Ultimately, whether that is what your employer wants or not, you are being paid to be a nurse, and your license requires the faithful execution of being a responsible nurse.

So, if a choice has to be made, you have a moral, ethical, and LEGAL obligation to be a good nurse OVER being a good employee.

It's really that simple.

When I worked in LTC, my philosophy was 'If in doubt, send them out." I'd rather be wrong about sending them out 9 times then be wrong about keeping them even once.

~faith,

Timothy.

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commuter,

you did the right thing.

your pt already had low bp.

had you cath'd him, you risked hypovolemia (? shock) if he had passed even 1000cc...as well his bp further plummeting.

you really need to treat our elderly w/kid gloves.

they just do not present similarly to the rest of the population.

ms changes could have been r/t meds in the hosp or even the anesthesia from the turp procedure.

given what his bp was w/existing confusion, i would have sent him out too.

you did what a prudent nurse should have.

don't let anyone tell you differently.

leslie

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Specializes in LTC,Hospice/palliative care,acute care.
there is rarely a need to call 911 from a SNF to send out a pt...911 is abused by MANY SNF staff...The situation did not warrant a 911 call, rather a PRIVATE ambo ride...

Nursing staff calling 911 too much, is my problem w/ SNFs sending pts to the ER...I was a w/e supervisor in a large SNF...In 2 years I called 911 TWICE (respiratory arrest, status epilepticus)...And we sent out patients semi-regularly

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In this area several private nursing homes (some in which I've worked) do NOT have contracts with private ambulance services so if a resident needs to go out for an eval after hours they go via 911....I work in a home that does have a contract with a service and every now and then they can not get to us within a reasonable amount of time and we have to call 911 if the resident is really unstable or in alot of pain that we can't relieve..In the last several years I think 911 has been called for employees and visitors more often the residents....
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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
there is rarely a need to call 911 from a SNF to send out a pt...911 is abused by MANY SNF staff...The situation did not warrant a 911 call, rather a PRIVATE ambo ride...
I have never called 911, not in this situation and never in my short career. In this situation I called a private ambulance service that has a contract with the nursing home where I am employed.
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in phoenix, MANY nursing homes just call 911 for fevers, falls, etc...

curious that you need a contract...every ambo company should be able to bill a patient's insurance/payor...it's cheaper than 911...

commuter...no implication that you called 911...another poster mentioned it in passing regarding your situation...

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in phoenix, MANY nursing homes just call 911 for fevers, falls, etc...

curious that you need a contract...every ambo company should be able to bill a patient's insurance/payor...it's cheaper than 911...

commuter...no implication that you called 911...another poster mentioned it in passing regarding your situation...

Not true in PA. We have two main companies that do transports for our facility (there are a few other small ones) We use one primarily but call the other depending on insurance. Sometimes the wait times warrant a 911 call and normally the private companies will direct me to call them. Now...I have a pt in full arrest...darn sure I'm calling 911 with a response time to us of 3 minutes.

Lets remember that nursing home is a blanket term now days. Many LTCs are functioning as sub acutes with younger and sicker patients.

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Lets remember that nursing home is a blanket term now days. Many LTCs are functioning as sub acutes with younger and sicker patients.

soo true!

one of the reasons I left "LTC" was the ever-increasing acuity...and the younger and younger ages, and the increasing number of medical problems blamed on "spider bites"

a 35 year-old junkie w/ bad foot cellulitis, admitted for PT...he is always at the med cart, and he chews his percs...not a place for grandma anymore!

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when I left, my SNF/LTC wanted to admit pts on insulin drips, chest tubes, and psych pts as well...

one place in phx won't admit smokers, those younger than 55, and NO ONE w/ state aid (medicaid) as a payor...I interviewed there...immaculate...

LTCs (now) are the tele/med surg units of 10 years ago...w/ less than adequate nursing coverage

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