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,".
I can't imagine a nursing home in my area not calling report to us in the ER when they send a patient over. The thing that really irks us with LTC nurses is when they don't use common sense. Just this week we had them send over a patient whose O2 sats were allegedly 55% on room air. When they put on 2L NC, it went up to 100%. It never occurred to then that their first reading was most likely erroneous. We get things like this a lot in our rural area. Although they don't always think things through, I will say I am always impressed with the condition of the skin on their bedbound patients! I can't imagine how time consuming it must be to keep those patients cleaned, turned, and breakdown free!
All of your frustrations seem very valid, and i thank yoi for your reply. And to begin we have bad lazy nurses in LTC who would rather pass the bucknon the next nurse rather than send a resident out for eval just to clock out on time. So when the next nurse sends them, there bad off. Just like im sure there are lazy ER ,OB, Home Health Nurses etc. this post was by no means to inply perfection on the LTC Nurses part no no.
Sometimes im just as baffled as you sre when its evident some residents just fart the wrong way, and the doc says send to ER for eval stat! Like what even?? They fell on ma padded mat on there butt and have no bruises or pain. I get it, trust me.
Thirdly, thanks for your last question , because the SAME issue exists at the LTC i practice at. Well look at it this way! Its 1:00 oclock in the morning, we are cut half on CNAs. You try to call the driver that works 7a-3p do they answer? No! So you call the DON thenDON says send one of the CNAs. The CNAs are making rounds the call lights are going off ninety to nothing. You ask CNA 1 to take the nursing home van to get the resident, CNA 1 claims she cant because CNA 1 does not have the Class of drivers license to drive that van. But CNA 3 who is working the lockdown dementia unit tonight does. But CNA 2 cant go sit back there right now because CNA 2 is a male and Mrs. Smith only likes CNA 3 to change her @ 2:00am, becausr with the other CNAs ms smith will pull her PEG tube out and become demonic. Call the Nursing Facility Admistrator but the can ABSOLUTELY NOT come back by ambulance becausr of the price of transport or non skilled patients. Therefore at no fault of the Charge LPN/RN on duty who cant leave the facility, or the ER Nurse, the resident may sit an extra 2 or 3 hours in the ED unneccessarily. Frustrating yes... I get it.
All of your frustrations seem very valid, and i thank yoi for your reply. And to begin we have bad lazy nurses in LTC who would rather pass the bucknon the next nurse rather than send a resident out for eval just to clock out on time. So when the next nurse sends them, there bad off. Just like im sure there are lazy ER ,OB, Home Health Nurses etc. this post was by no means to inply perfection on the LTC Nurses part no no.
Sometimes im just as baffled as you sre when its evident some residents just fart the wrong way, and the doc says send to ER for eval stat! Like what even?? They fell on ma padded mat on there butt and have no bruises or pain. I get it, trust me.
Thirdly, thanks for your last question , because the SAME issue exists at the LTC i practice at. Well look at it this way! Its 1:00 oclock in the morning, we are cut half on CNAs. You try to call the driver that works 7a-3p do they answer? No! So you call the DON thenDON says send one of the CNAs. The CNAs are making rounds the call lights are going off ninety to nothing. You ask CNA 1 to take the nursing home van to get the resident, CNA 1 claims she cant because CNA 1 does not have the Class of drivers license to drive that van. But CNA 3 who is working the lockdown dementia unit tonight does. But CNA 2 cant go sit back there right now because CNA 2 is a male and Mrs. Smith only likes CNA 3 to change her @ 2:00am, becausr with the other CNAs ms smith will pull her PEG tube out and become demonic. Call the Nursing Facility Admistrator but the can ABSOLUTELY NOT come back by ambulance becausr of the price of transport or non skilled patients. Therefore at no fault of the Charge LPN/RN on duty who cant leave the facility, or the ER Nurse, the resident may sit an extra 2 or 3 hours in the ED unneccessarily. Frustrating yes... I get it.
Please proofread your posts before posting. It is challenging to read them.
ICU nurse here. Mad respect for the LTACH nurses. No need to divide up the profession.
"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?
Here is the thing. Resident had rising BGs due to prednisone where the physician all week had informed of the rising BGs and said "ok" She was also diaphoretic, elevated BP from her normal earlier in the shift, rapid pulse. The "bump" was caused by something little although that is what the family was focusing on. We were looking at the whole picture as well as had been seeing a deterioration all week and before the bump. Yes, something little as a small object had fallen near her and bumped her on the forehead, yes a small object that weighs a few ounces. It was the family who arrived before the ambulance who told them it was a head injury, not us either. Added to that everytime we call this particular hospital for the on call Dr., we get put through the ER and the nurses tend to be rather snippy on evenings and nights.
Thirdly, thanks for your last question , because the SAME issue exists at the LTC i practice at. Well look at it this way! Its 1:00 oclock in the morning, we are cut half on CNAs. You try to call the driver that works 7a-3p do they answer? No! So you call the DON thenDON says send one of the CNAs. The CNAs are making rounds the call lights are going off ninety to nothing. You ask CNA 1 to take the nursing home van to get the resident, CNA 1 claims she cant because CNA 1 does not have the Class of drivers license to drive that van. But CNA 3 who is working the lockdown dementia unit tonight does. But CNA 2 cant go sit back there right now because CNA 2 is a male and Mrs. Smith only likes CNA 3 to change her @ 2:00am, becausr with the other CNAs ms smith will pull her PEG tube out and become demonic. Call the Nursing Facility Admistrator but the can ABSOLUTELY NOT come back by ambulance becausr of the price of transport or non skilled patients. Therefore at no fault of the Charge LPN/RN on duty who cant leave the facility, or the ER Nurse, the resident may sit an extra 2 or 3 hours in the ED unneccessarily. Frustrating yes... I get it.
Thank you for answering my question. We will call the ambulance for transport, or a taxi if the person is ambulatory. We do have medical transport available, but only for limited hours, and often it takes too long for one to be available. We can't let the person sit there that long, as we need the bed. Seems like there is a better way though, considering how expensive an ambulance is, and that a rig is being tied up for a non-emergent transport, and taxi drivers are not trained health care workers.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
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.
It's a post that should have been proofread. It's difficult to see you as professional, courteous and possessed of sound nursing judgement and competence when your verbal communication has so many glaring errors. And yes, you're busting on ER nurses.
We all have a difficult job, and I have to admit that I don't fully understand the perspective of the ER nurse. That's OK -- I do respect that they HAVE their perspective, which is different from mine. I don't understand the perspective of a LTC nurse, either but I'm very, very grateful for the wonderful LTC nurses who took care of my mother in the later stages of her Alzheimer's. I don't understand the OR nurse -- when she calls report to the SICU she sounds like an utter moron. "What drips is he on?" and "Does he have a central line?" seem to be complicated questions that she's not qualified to answer and I often wonder exactly how someone could become a registered nurse without being able to answer these questions about any patient in their care. On the other hand, when I've been a patient in the OR, delivered a patient to the OR or gone to the OR to dialyze someone, I've seen the complex working environment and many "balls in the air" an OR nurse routinely juggles. I don't get the floor nurses, either -- how come they're never ready to take a patient that's been posted to them for ten hours when my SICU patient is coming out of the OR in ten minutes? Of course I used to BE a floor nurse, so a few minutes reflection (when I have the time for that) and I WILL get it.
One should never assume that the person giving or receiving report is stupid, incompetent, lazy or rude. We all know that they could be over worked, understaffed, trying to flag down a physician to look at another patient's funky CXR while juggling your phone call and the family member staring accusingly at them.
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.
I was thinking the same thing.
Once upon a time, I worked for a SNF that was attached to a hospital that was highly rated and growing very quickly. As a result, we grew very quickly. And tempers grew quickly as well lol.
After several complaints back and forth, our facility set-up meetings with the hospital to find out the problem. Initially, it was our Social Worker meeting with their entire team of Social Workers. She would come back beat up, red in the face and near tears. The DON was supposed to go with her, but due to the whole situation none of our DON's stayed long enough. I was asked to go.
Mind you, at the time I was just a floor nurse in charge of the busy Step-down unit. The only people I had to deal with up to that point was the patients, family's, Docs, nurses and other medical personnel. I was scared to go but was told I had no choice.
We sat at these huge long tables, the Social Worker and myself at one end and surrounded by the hospital staff. Most were Social Workers, some ER docs and nurses and a few others, not sure who they were.
At first, they tried to beat our SW down, critical of our admission process, how we d/c'd to the ER, questioned why we needed so much info and time prior to admit and on and on. As I watched her being 'PC' and not making waves, I was becoming more and more angry. So yes, I opened by mouth and spoke up. I had to educate them about things like, life support, not doing the 'Friday night dump', not sending us 5 to 7 patients all within an hour, and the biggest contention they had is why we could not accept an obese patient at 6pm with only a 5pm notice of Friday (we only have so many supplies and have to order things). Ditto for the vents/trachs.
They were so surprised that we could not simply call down to pharmacy to send up all the IV equipment or narcotics in a flash (I highly encouraged pre-medicating those in pain to give us time to force our pharmacy to send an emergency supply), that we don't have some magical place where we keep all the same equipment they could and much more.
In the end, we educated them. They educated us (our nurses really needed to give a better report with just the facts and for those with dementia, their quirks and how we handle it). Many times, the nurses would call the MD, call the ambulance and 'forget' to call the ER. We found that when we called and were prepared with not only the admitting reason, but a brief history which includes their allergies, meds and most frequent pain med time and BGM, the ER was oh so much nicer. So much more accomodating when we called, and no, they did not speak to us like we were imbiciles or beneath them.
And our admission process was absolutely the best of any facility that I have ever worked in prior or since. They, the hospital staff, listened. They educated their staff as we educated ours. We would get their H&P, most recent labs and med list 1 hour PRIOR to their admission!!!!! Can you imagine? This worked so well that we could easily have a nurse on hand just to begin the paperwork, order supplies, beds etc and when the patient rolled in on the cart, someone was waiting their to greet them in a room that was ready by an mostly, unharried nurse. Beautiful!
I just can't get over the part about not being able to suction without an order in the original post.
I'm not picking on LTC nurses here, just this particular point, but... you seriously wouldn't suction the patient and get an order later? If the patient was a full code and had some thick secretions in his airway and was becoming hypoxic because he was unable to clear his secretions... it would be okay for him to code or suffer an anoxic brain injury? Letting harm come to a patient is preferable to doing something to help?
I just can't get behind that. No matter how busy the nurse is with other patients, no matter what policy says... I can't get behind someone who would deliberately endanger a patient just because of policy.
Furthermore, if a patient under your care died or suffered an adverse event due to hypoxia which could have been prevented if you suctioned the patient, that judge looking over your malpractice case when the family sues you probably isn't going to ask you what the facility policies are and give you a pass.
You mentioned protecting your license, so just keep in mind - following job policies protects your JOB. Acting as a reasonable and prudent nurse protects your LICENSE. If these two things conflict, be the reasonable and prudent nurse, not the rule follower - you can always find another nursing job if you get fired for breaking facility policy, but only if your nursing license is still intact.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I just can't get over the part about not being able to suction without an order in the original post.
I'm not picking on LTC nurses here, just this particular point, but... you seriously wouldn't suction the patient and get an order later? If the patient was a full code and had some thick secretions in his airway and was becoming hypoxic because he was unable to clear his secretions... it would be okay for him to code or suffer an anoxic brain injury? Letting harm come to a patient is preferable to doing something to help?
I'm wondering if they would even have suction, suction catheters, etc. I'm sure that with an order they could obtain such equipment, but LTC may not have such things sitting around in patient rooms.
ktwlpn, LPN
3,844 Posts
Because the resident is your patient at that time.Most LTC's don't employ a round the clock driver .....