Tension between Nursing Home Nurses and Acute/Critical Care Nurses! Lets visit!

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Specializes in Nursing Home.

Often on this site we see forums about nurses versus allied health professionals. But as you well know the same tension exists, between different nursing professionals. So basically this is what this thread is about.

Let's talk about what LPN or in some cases RN floor nurses in LTC would classify as the "The rude emergency department nurse ". And again, this is not to stereotype all ER Nurses as i have called in report to many awesome life loving positive ER Nurses. I never worked as an ER Nurse, so i do not know the struggle, but i was hoping this post would give the "Lazy Imcompetent LTC Nurse" and the "Rude Bitter ER Nurse" as classified by one another a chance to share wach others frustration.

So at this time, im going to speak for the "Lazy incomptent LTC Nurse" and share some of our struggles and frustrations.

1. Chatting with a residents primary physician, obtaining physician order for the resident to go to the hospital, calling report to the hospital and meeting resistance from the ER Nurse.

A. While i know that in my heart of hearts that not every single LTC fall warants an ER visit. But when the doc says send them , they must be sent. Even if i know the resident is fine. Its the way it is. Some doctors put full trust in the assessment skills of LTC Nurses, others are overly cautious (they earn that right with 8 years of medical school). So the orders you bark when we call to give you report, well there gonna go in one ear and out the other. Because to be very bluntly as a Nurse im not taking an order from a Nurse. A doctor has given me an order, ane in order to protect my license i will do my duty as a nurse abd carry out the order. So wasting your breath barking orders will just raise your blood pressure, and take me away from the other 42 residents under my care. At the end of the dat whether you take my courtesy report or not, they will still be coming to your ER so make the most of my willingness to be polite and give you as much info as possible because when its over and i feel you are trying to bully and harrass and pitch a fit, the phone will hang up and my DON will back me up.

2. NOT UNDERSTANDING POLICY

A. As i assume, you ER Nurses are used to just doing. Suctioning, U/As, reinsertions of enteral tubes, Nebs, reinsertion of suprapubic catheters etc. etc. And just cant understand wvu this cant just be done at the nursing home, its not the incompetence of the nurse, its facility policy. So no, we did not suction, because we have no order to so. Call our facilities Director of Nursing, Adminstrator, Corporate Nurse Officer, Medical director, If you wish to voice your concerns. But please dont take ir out in the LPN on the floor who is trying desperately to finish a 40 patient med pass, and complete 10 skilled nurses notes, and all the hospital transport paperwork we didnt write

the policies.

3. No we cannot call to mind everything about our residents like ICU and ER Nurses can. We do not know every allergy our residents have, or every dx a resident has. Just like doctors who care for maby patients, we have to reminded and reminded and remind ourselfs. So when we cant answer a question without doing a little reseach dont write us off as guilty of incompetence or laziness.

Just a few , but i encourage you guys to share the ER Nurse struggles and what frustrates you the most. Im going to quote the Assitant Director of Nurses at our Nursing home who has been an LPN for 27 years and one the best i know! Take it with a grain of salt.

"Ive done Med Surg, Ive done NICCU, ive done ICU, i was an ER Nurse at a rural hospital, i was a home health nurse. But, nothing compared to the stress being in a facility full of stable elderly residents, as crazy as it may sound,".

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Specializes in ICU.

This post will possibly earn you some scathing comments. I work er and ICU both. And this post serves no point except to promote division among areas of nursing.

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Specializes in Dialysis.

I've done ER, ICU, home health, med/surg, hospice and ltc. Every area has a different perspective. No, we shouldn't be divided. But honestly, its hard to see outside of your own perspective at any given time. And fwiw, none of us knows what's been going on on the other end of that phone. Whichever end you're on, please practice courtesy. Someday, it may be you or a loved one that the call is all about, and you would want each piece of critical information conveyed and critical questions asked and answered. I've been on both ends of that phone. I just hope I've always handled it as well as I've tried to put into words here

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Specializes in LTC,Hospice/palliative care,acute care.

I agree in part.EMS and ED staff often seem to think "DNR" means "do not treat" and can be a bit judgemental when they perceive acute care assessment and treatment is futile but it's not up to them or us.....However when you call to give report you SHOULD have the resident's history,allergies,meds at hand.Even though you are sending copies of everything be ready to answer those question.In my experience when I give a concise report with confidence I don't get peppered with a bunch of questions.

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Specializes in Psych, Addictions, SOL (Student of Life).
I agree in part.EMS and ED staff often seem to think "DNR" means "do not treat" and can be a bit judgemental when they perceive acute care assessment and treatment is futile but it's not up to them or us.....However when you call to give report you SHOULD have the resident's history,allergies,meds at hand.Even though you are sending copies of everything be ready to answer those question.In my experience when I give a concise report with confidence I don't get peppered with a bunch of questions.

Her, here! Unless it some crazy scoop and run emergency. I pull up the patient profile and give a full report to the receiving nurse - that's just good nursing (and yes I too have to pass meds to upwards of 30 patients as well as oversee the entire unit). Most of the ER nurses in the area know our facility give top flight care and trusts our reports.

Hppy

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Specializes in LTC,Hospice/palliative care,acute care.

Am replying to the OP who claimed she could not recall everything about HER residents.....

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Specializes in Dialysis.
I agree in part.EMS and ED staff often seem to think "DNR" means "do not treat" and can be a bit judgemental when they perceive acute care assessment and treatment is futile but it's not up to them or us.....However when you call to give report you SHOULD have the resident's history,allergies,meds at hand.Even though you are sending copies of everything be ready to answer those question.In my experience when I give a concise report with confidence I don't get peppered with a bunch of questions.

And I have the MAR and hx at hand. I have given info to ER nurse only to be asked 'is she on x med?', which I had just said (usually lasix). And I'm sure when I was in ER, I asked a question that the nurse on the other end had just told me the answer to. So both sides are guilty. Believe me, I've been on both sides!

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Specializes in Nursing Home.

Woah woah woah ! Lets back it up ! First of all, im a proud male nurse! Second of all , the comments are heading in the direction. The post was not meant to ruffle feathers or take anything away from great ER Nursew who sabe many lives in an absolute great area of nursing! This post is to maybe give these EE Nurses who have done this life an insight to a different enviroment. make no mistake about when i call to the ER i got thre allergies , the problem, the V/S, the basics, but when the ER Nurse asks me what day did they have there stroke, what all medications are they on that could cause this or that, well ill be hapy to get that for you but ill have to loom it up! Sometimes that turns into rudeness, and uncoopetation, and if you continually try to degrade my judgement or competence i will hang up the phone! And the DON has no problem with that! When people go to the ER from there home they get no report. Im polite im couteous, but i a good nurse, if you insult my judgement and competence , then when your ready to call back and focus on the "Resident" we will talk. Its common courtesy! I can call the ER and have seven kinds of attitude because it wasnt my schedules day the med pass interupred but i dont. Its common courtesy. And reply to the above poster comment yea we should all get along but we dont. Simply because of altered perception r/t lack of personal experience aeb everyday reppetive issues. So i feel this is a good place for us to give insight to each other from one area of nursing to another. Its a blunt post not a degrading or derogatory post.

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When I worked in Ltc I never called the ER to give report.

I did send copies of the MAR,TAR,and 485 with the patienT.

What would be the purpose of calling when things are easy to forget?

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Specializes in LTC and Pediatrics.

There is one hospital I do not like to call ever. Since I usually call after hours working evenings, I am sent to the ER nurse. At this place they can be rather snippy. Tonight, we had to send a resident to this ER. She had many things going on, but the family was focusing on a recent situation where the resident ended up with a "goose egg" bruise on her forehead. Well, the family got to the ER before the resident did as we are 20 minutes away. The nurse calls and wants to know about why this resident is coming and what about the head injury and really treating the nurse who answered the phone rudely. When this nurse was able to tell her what was going on, the ER nurse wanted to know if certain papers were sent. Yes, they are. She also wanted to know when the ambulance left. Well, it was still sitting behind our building. She then wanted to know why? How the heck were we to know why. They had taken the resident to the unit, she was now in their hands.

A doctor put her on a high dose of prednisone for some sort of long named algia a week ago. Her blood sugars were ramping up higher every day. The doctor would keep telling is to just watch it. What? There were many more issues. The bump on the forehead was the least of our worries at that point.

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I typically do not receive report on patients brought from LTC. The medics bring copies of the MAR, face sheet, resident info sheet, advance directive, etc. I might call if I have questions that need clarification, but otherwise we go by the medic's report.

Sometimes it seems as if the LTCs send patients in for farting sideways, and other times we wonder what took so long for someone to decide this person needed to be evaluated in the ER, and sometimes it's completely appropriate that they were sent in at the time they were sent in for the reason they were sent in.

I know that the LTC nurse has 30+ residents they're caring for, and I understand that your hands are tied when it comes to things as simple as obtaining a cath UA, blood test, chest xray, or reinserting feeding tubes or indwelling catheters. I understand that when you call the doctor about one of your residents, the doctor will recommend sending them in or not without having even laid eyes on them. I get all of that.

My question is, why can't you help get the person back to the facility at discharge from the ED?

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"The bump on the forehead was the least of our worries at that point."

Maybe this is one of the things that irks the snippy, know it all ER nurse...least of your worries huh? Subdural hematoma ring a bell?

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