VA's

that's terrible, especially having the guy drive himself in his car for an emergent tracheotomy. No excuses there.

But...I know a lot of VA nurses and they are some of the kindest, caring, committed professionals I know, so to generalize all of them together based on experiences at your local VA would be unfair.

They have a medical director in their ER and I'm sure if your director contacted him/her and expressed concern over these situations it would be addressed and maybe things would improve. I've been frustrated with VAs before too (and I'm a vet).

Your comment about all VA hospital staff are "dumb" is very unfair! I work at one of the major VAs and we receive pts that the smaller surrounding VAs don't have the resources or certain staff to take care of. There are over a thousand VA facilties in the United States, so to sterotype all of them just because of your experience with one of them is not fair. If you are curious about why they are "dumb", find out what services they offer which would give you an idea of what doctors are availabe for certain emergencies. Some smaller VA facilities only offer nonemergency servies, and for emergencies they will send them either to the closest major VA or the closest hospital. If you stay in a smaller town, city, ect, then its a possibility that the particular VA facility you are referring to is not one of the major facilities and therefore only offer certain services.

Just curious if the VA hospitals near you guys suck! We have one close by and they are constantly sending us things they can't handle or diverting ambulances to us. Or they plain don't answer the radio so the medics come to us by default. In fact we have called them from our hospital to say answer your damn radio. I feels so sorry for vets at least in our neck of the woods.

This weekend we had one that topped the cake though. A poor gentleman with some kind of tumor in his throat was supposed to be admitted to the VA. Well when he got there they decided he had stridor, couldn't breath, and needed an emergent tracheotomy. They called and said he was on his way. Great at least they gave us a heads up. Well he pulls up DRIVING HIMSELF IN HIS CAR!!! The ENT met him in the room immediately ready for this life saving procedure. The guy looks great, vitals are great, denies EVER having trouble breathing. The ENT has him walk, lies him flat...no stridor or sob. He scopes him to take a look and sees a non obstructing tumor. Back to the VA he goes for routine follow up with an ENT there. How dumb are these people???

First I was not saying ALL VA's are terrible thus my very first sentence asking how they are in your area. I obviously don't know and that was the whole point of this thread to see if it's a local problem or a wide spread one do to funding or whatever.

I NEVER stereotyped and I never said ALL VA staff are dumb. Please read my comments before you attack me. I did state the ones that sent this particular patient to us were dumb. Who thinks someone needs and emergency trach and sends them by car? Who thinks a guy who is walking, talking, and denies difficulty breathing needs and emergency trach in the first place...DUMB!

We have had a lot of problems with our VA. It is supposed to be a full service VA except for major trauma or serious medical. Those are diverted to us which I think is fine but the staff has to be intelligent enough to know when a true emergency exists. In general they are terrible and I've had several Vets say that to me when they are being treated in our ER. I feel terrible for them. The next closest VA is 2 1/2 hrs away and they do have to go there for some things. There was talk about closing our VA down a few years ago but I haven't heard anything about that recently.

I wasn't trying to attack you. Just defending the system that I work for. I really don't want to turn this into an argumentive thread. But it did seem like you was doubtful of the care that all VA facilties give, due to you bad experiences with one of them. And no, all VAs aren't terrible. If you truly believe that this particular VA put a pt's life in danger, there are appropriate administrators to talk to about the decisions of that particular staff that sent a guy in his car who possibly needed an emergency trach. But then again, my reply isn't an attack, just a defense.

First I was not saying ALL VA's are terrible thus my very first sentence asking how they are in your area. I obviously don't know and that was the whole point of this thread to see if it's a local problem or a wide spread one do to funding or whatever.

I NEVER stereotyped and I never said ALL VA staff are dumb. Please read my comments before you attack me. I did state the ones that sent this particular patient to us were dumb. Who thinks someone needs and emergency trach and sends them by car? Who thinks a guy who is walking, talking, and denies difficulty breathing needs and emergency trach in the first place...DUMB!

We have had a lot of problems with our VA. It is supposed to be a full service VA except for major trauma or serious medical. Those are diverted to us which I think is fine but the staff has to be intelligent enough to know when a true emergency exists. In general they are terrible and I've had several Vets say that to me when they are being treated in our ER. I feel terrible for them. The next closest VA is 2 1/2 hrs away and they do have to go there for some things. There was talk about closing our VA down a few years ago but I haven't heard anything about that recently.

I've had experience in the VA system. One was superfantastic and the other was a nightmare. I began moonlighting in an ER at a rural VA Medical Center. At the same time, I was also working in the regional trauma center. I was accustomed to working with the ENA protocols and standards. The rural VA had great nursing staff- all very bright, eager, and excited about taking care of our vets. What amazed me was the times when I've had to pull a near dying patient from the vehicle when I had suggested they call 911 a few hours prior to their arrival. Their rationale was that they could not afford to go to their closest ER. I would educate them that the local ER would stabilize them and transport them to the ER. It didn't matter. These vets have been trained throughout their years with the VA to "hurry up and wait" and that "everything closes down at 4:30pm-even if you're dying." Of course, I'm exaggerating a bit but if you all have experience with the VA system, I'm sure you've heard those quotes. I do believe the culture is changing and I am so happy about that. For the most part, the vets I cared for were always so appreciative of everything I did for them. I felt very honored and rewarded during my tenure in the VA system.

I can recall my first day at the VA..I was standing in line to get my name badge. I had to go to the intake clinic to do this. The intake clinic was where vets went to get signed up for the first time...but it was also the check in for the ER. While I was in line, I met a gentleman who was having chest pain. He was standng about 2 or 3 people behind me in line. I noticed he was diaphoretic and ashen looking. I was trying to get him to the head of the line but he was ever so polite and kept saying that he'd wait. I finally grabbed a wheelchair and just wheeled him over to the nurses station so he could get prompt treatment. He was in fact having an MI. During my first few weeks, I encountered situations where patients who were in the ER to rule out an MI had to walk over to the radiology department to get their xray. These examples were common place. I'm really proud to say that my co-workers and I were able to change the culture of that VA- to follow the standard of care so our patients received safe and timely health care. I have fond memories of my experience there.

However, I later transferred to a large tertiary VA Hospital in Florida and worked in their ER. They did not have enough exam rooms to take care of the sheer volume of patients. That set up was destined to be disasterous. The nursing staff had little to no trauma experience. They had no set triage processes- it was first come first serve. We had all kinds of things happen in the waiting room that would just give you nightmares. Most ERs have an element of chaos to them. It's that uncontrollable chaos that kept me from sleeping during my time off. I had grown fearful of losing my nursing license because of something I couldn't control. During my last month in that emergency department, we had 3 sentinel events. Thankfully, my name wasn't anywhere near those charts. I made suggestions to the Medical Director and the Nurse Manager about possible protocols and processes to develop. They loved what I had to say. In the end, I felt as though that battle was more than what I wanted to tackle at that point in my life. I chose to leave in order to protect my career. I don't think their issues were due to people not caring. I think the overhaul that was required for that ER was so massive and overwhelming that no one really knew how to begin. I bet their were issues with the funding of such a project as well. I've thought about that place a few times and wonder if improvements have been made.

My father goes to the VA Hospital in Oklahoma. I have to say that he has received nothing but top knotch care. I'm highly critical of healthcare when it comes to my family members. But I've got to say I've been impressed. Not only has his care been exceptional...it's been timely. Kudos to the Oklahoma VA system!!

Bottom line~ every facility is unique. They all have their own culture as well.

I agree with you! Not every VA gives horrible care and incompetent. But I do have to say that the protocols and what each VA is able to do is govern by the Government, who is always budget happy, and everything takes soooo long to get approved: more staffing, up-to-date equipment, ect.

And it is very common for a vet to drive to the VA, skipping several hospitals on the way, to get treatment for a MI or stroke. Several years ago, I had a pt who suddenly lost vision is one of his one morning, and drove himself 4 hours to the nearest VA because he didn't have insurance and didn't want to pay the bill for the ambulance and non-VA hospital. In another case a vet who was driving a semi started having chest pain, he drove 8 hours to our VA, pulling over along the way to pop nitro and get over his dizziness. It was scary because he took almost a WHOLE bottle of nitro, while driving a semi!!!! It don't matter how much education and chastising we give to most of these vets, they will still think about costs.

I totally agree with your last sentence that every facility is unique. What's experienced in one facility will most likely not be experienced in another.