Should I question their training?

Keep_Calm · Mar 7, 2013

It sounds horrible, I know. BUT--when you get into LTC, things change a little from a medical standpoint. A lot of nursing home residents have advanced directives-DNR or DNRCC. Sometimes there's a gray area as well where the family makes the call whether or not they want their loved one to go to the hospital or not. A lot of elderly, especially alzheimers and dementia patients, do HORRIBLE in an acute care setting because they get even more confused and in turn, they suffer MORE from being there. Sometimes a family or doctor may take a "wait and see" approach when a resident's health starts declining, so not to put them through unnecessary suffering. Then the family will maybe decide after a day or two that, yes, they do want them to go.

I used to think some LTC nurses were dumb also, until I started working in one. There are a lot more legal and ethical aspects of LTC vs acute care that I never realized. Some facilities have idiotic policies (like calling the squad to put O2 on someone--thank god not mine) and some MDs make stupid decisions also. Also, an LPN in LTC has a lot of responsibility, but little say when it comes to some important decisions.

AND--CNAs/STNAs, while GREAT, do not have much medical training and do basic patient care, and one would not know enough about someone's condition to accurately tell you anything.

CapeCodMermaid, RN · Mar 8, 2013

TED RN to Be...RNs have gar more medical training that EMTs....don't go down that road.

Nascar nurse, ASN, RN · Mar 8, 2013

TED RN to Be...RNs have gar more medical training that EMTs....don't go down that road.

Awe...I've been waiting to see your response to this all night. I admit I'm feeling let down. Probably should have tackled it myself but my Daddy always said "if you don't have nothing nice to say then keep your d_ _ _ mouth shut". Ted, let's just leave it that as an ambulance driver YOU are not qualified to ask nor judge any licensed professionals qualifications. TED_RN_TO_BE - you can breathe a sigh of relief.

TED_RN-to-be · Mar 8, 2013

I understand what y'all are saying. I'm learning as I'm on my journey to get to and through nursing school. What do y'all usually do whenever you first learn that your patient is experiencing something like that in a LTC facility?

WhereIsMyCallBell · Mar 8, 2013

Do a full focused assessment ie. are they a cardiac pt,. COPD'r, post CABG, etc... Obtain manual vitals, none of that wrist cuff, temporal temperature stuff, get a rectal temp for heavan's sakes! Question LPN,s and CNA's about changes in LOC and condition... What can I do as an RN to stablize this pt? Call MD. Orders, or send out? I have been in LTC 7 yrs now. There is also an intuitive type thing I have developed. I take all of that into consideration. If DNR call POA. Full code emergency. Give CPR if necessary and have someone call 911 stat. If they are a DNR and family doesn't want them sent out. Make the patient as comfortable as possible within my scope of practice. Follow MD orders if given to facilitate comfort and notify family. YES some of us LTC nurses have a brain and training too! But that's me, I can not speak for all LTC nurses.

Keep_Calm · Mar 8, 2013

What do y'all usually do whenever you first learn that your patient is experiencing something like that in a LTC facility?

It depends entirely on the situation.

CT Pixie, BSN, RN · Mar 8, 2013

I am currently an ambulance driver for a private company and will soon be an EMT in a few weeks. We mostly transport patients from nursing homes and rehab centers. There has been plenty of times where I have been frustrated by the employees of those facilities. Sometimes we get called to a nursing home to take a nonemergent patient to the ED. There was a time when we would approach the unresponsive patient whose vitals were all abnormal. We would then ask the CNA or LPN how long they have been in that condition. Then they said, "Oh, about 2 or 3 days." Are you serious?! The patient has UNRESPONSIVE with crazy vitals for that long?! All I could think to myself was "Wow" and we took the patient to the ED. That same situation happened a week later at a different facility. Did they actually receive any medical training at all?

Why are you asking the CNA about the patients condition?!

And YES the LPN has FAR more medical training than an EMT. And I'm speaking from both sides of the fence. I am an EMT and an LPN.

As the others have said, many times the family does not want anything done for a few days, then they decide they want the resident sent to the ER. Without knowing the specifics you have no right to judge the medical training (or lack of) of the LPN.

Nascar nurse, ASN, RN · Mar 8, 2013

Do a full focused assessment ie. are they a cardiac pt,. COPD'r, post CABG, etc... Obtain manual vitals, none of that wrist cuff, temporal temperature stuff, get a rectal temp for heavan's sakes! Question LPN,s and CNA's about changes in LOC and condition... What can I do as an RN to stablize this pt? Call MD. Orders, or send out? I have been in LTC 7 yrs now. There is also an intuitive type thing I have developed. I take all of that into consideration. If DNR call POA. Full code emergency. Give CPR if necessary and have someone call 911 stat. If they are a DNR and family doesn't want them sent out. Make the patient as comfortable as possible within my scope of practice. Follow MD orders if given to facilitate comfort and notify family. YES some of us LTC nurses have a brain and training too! But that's me, I can not speak for all LTC nurses.

Hindsight...you may want to re-read the entire OP. He/she is DRIVER...not an EMT and not a nurse. He/she has NOT been trained to do assessments.

CoffeeRTC, BSN, RN · Mar 12, 2013

TED...If you have any concerns, I recommend you first start off with the EMTs/ Parmedics that are on your team, they might be able to answer some questions.

If the EMTs/ Paramedics have any questions etc (they should be getting report from a nurse when they enter the building) then they need to ask a NURSE...not a CNA. The nurse will be able to provide the accurate information that is needed.

There a quite a few threads in the LTC section that discuss our (nurses) frustration in send some residents off to the hospitals etc when we know that they can be treated in a LTC. It is not always our call but often times the families. The MD gives the orders in the end.

SleeepyRN · Mar 15, 2013

TED RN to Be...RNs have gar more medical training that EMTs....don't go down that road.

Agreed. It's ignorance. I read an article recently by a paramedic instructor that was aimed at his students. It was basically telling them they have no clue what LTC nurses do or the level of knowledge they have. We had a meeting a few months ago with the NPs of our residents, and they were telling us of changes regarding sending a resident out. They are trying to keep residents in house as much as possible. I remember one particular resident that we nurses wanted to send out so bad. Day after day of treating with IV fluids and the resident was not getting better. The MD and nurse practitioner kept refusing when we said we wanted to send the resident out. The last I heard of that situation before I resigned was the ADON was going to talk to the family and have them request the resident be transferred out. Again, very ignorant comment on the OPs part.

HippyDippyLPN · Mar 15, 2013

As an LPN I have many a times called the MD because I saw urgent signs that a resident in LTC needed care only a hospital could give to be told the POA says wait, md says do this and this then we will see, or other miscellaneous reasons. I can't make that call unless someone is too much of an emergency to wait to call the md and are a full code. And per my facility you better be damn sure that resident is on their way out to the other side if you call squad before notifying charge or md. Usually my charge is within close enough distance I can pull her in as I race down the hall so she can make that call with me. Covers everyone that way.