OK- just let me say up front, this is NOT a flame of LTC nurses. I want your opinion about something.I'm an ED nurse who has worked in your shoes as well, and I understand how hard your job is, and how much good you do on a daily basis. There is a certain amount of discourd at times, between LTC and Hospital nurses- I've heard (NEVER SAID) that people who can't "handle" the pressure of working in a Hospital have to go to a LTC because they don't have the necessary smarts, skills, coping mechanism, ect. to "hack" it in the real world.(I disagree with that statement). I've precepted students who have actually said things like this, so I'm not sure exactly where it comes from? I also understand that our priorities are different from LTC nurses, based on what we do for our patients. Something happened the other day involving a LTC pt. that left me flabbergasted!
I got a 62 yo male with acute/rapidly advancing dementia. His wife of 2 yrs is at the bedside. He is aggressive, aggitated. According to the wife, he was "normal" 2 yrs ago, but the dememtia is rapidly getting worse. So much for the man she married (sigh...) So this man was sent to me from his LTC facility for "UTI". He had had a Foley cath placed 2 weeks ago d/t inability to void/prostate issues, and is supposed to be waiting for a Urology consult to be arranged by the LTC faclitiy. The report I got was that the man had an indwelling Foley cath, foul smelling urine, temps, ect. OK- good pick up by the LTC place, right?
I undress this man, and find no leg bad- he's wearing sweat pants, with underwear, and 2 briefs on underneath that. THE FOLEY IS STILL IN...OPEN...without any type of bag/collection device, ect. draining right into the adult diaper. It's not clamped in any way- What the &%$#!!!!! I question the wife- according to her, the staff told her the leg bag/drainage bag "aggitated" the patient, so they just took it off. No way ANYBODY with a nursing license would do something that stupid, right? So I called the NH, spoke with the RN Supervisor. SHE KNEW about the situation- informed me that the NP had ordered it to be dealt with that way. I basically called her a liar (professionally, of course)- She said she'd fax me the written orders. She did, but all it said was that the man should be placed on a clamping schedule- So I called her back-told her that a clamping schedule would be appropriate, but was NOT the same thing as leaving Foley cath open. HELLO???? SHe then proceeded to backpeddle, saying that it was probably clamped, but that the man must have taken the clamp off. 1. There was no way the man could get to it with all of those layers, 2. the man's wife told me that they were lying, and that she had questioned it multiple times. How could ANY nurse think that was a good idea? I understand that the NH is their home, and things are done a bit differently than in a hospital, but seriously? Leaving a Foley open like that..then wondering why he got a UTI....I'm still amazed that anybody, let alone several nurses, could forget their training and think that would be appropriate? What do you guys think?
