What was she thinking?!

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Many of us are unaware that there are significant differences between post acute care/snf hospitals and acute care hospitals in terms of staffing, especially during the evening hours. SNFs do not have a receptionist after 6pm, which means the responsibility for buzzing visitors in and out falls on the nurse or CNA while they are still engaged in their primary duties. SNFs don't have a unit secretary in the evening so the phones may not be answered if the nurses and CNAs are tending to patients and not currently at the nurses' station.

I work the evening shift at a skilled nursing facility, and yesterday morning my patient was taken to the emergency room, and he was discharged last night. I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed.

Two police officers show up about an hour later at the facility to do a welfare check on my patient at the request of someone from the ER.

When I try to obtain details from the officers, they are also confused, but they do believe it has something to do with the PIV, but they do not have specific information. They leave without ever seeing my patient. As a result, I contact the hospital's emergency department.

This is what the charge nurse said to me.

During shift change, the ER nurse assigned to my patient realized she had not removed his PIV. Several attempts were made by her to speak to someone at the facility for no other reason than to inform them that she forgot to remove the PIV. When she was unsuccessful in reaching someone, a colleague of hers suggested she contact the police and request a welfare check be done. She took their advice and the rest is history.

I'm still trying to wrap my heard around this one.

Specializes in Mental Health, Gerontology, Palliative.
TsalibaRN said:

They wouldn't have had to do a CYA wellness check and waste officers time if someone answered the phones at your facility.   That's the real issue.  

Spoken like someone who has never worked in SNF or long term care.  I had 75 patients on an afternoon shift and 

I have 8 hours to do my job. The faclity hired me to be a nurse, not answer phones. 

When I got distressed family members who couldnt get through, I apologised profusely and encourageed them to register their displeasure with management. 

Quote

I also had the DON on speed dial so guess who got a call at her home, late?  Answer the phone

You say that like its some sort of threat. As long as I could account for my time (which I did) my DON basically played interference between folks like yourself and me doing my job. 

I get that the matter which you are blowing up phones for is the most important thing for you. What you don't get to see and what I cant tell you is the patient who falls and has a pulsating scalp wound, or the patient who falls in the garden most likely with a fractured #nof, possible midshaft fracture of the femur, or the patient who has some sort of cerebral event not for resus but we still need an urgent medical review or the end of life patient who is in screaming agony and whose pain medication arent touching the sides of the pain needing urgent palliative review. None of this covers the routine things like medication administration, food, water, personal caress etc I've had shifts that by the time I had a chance to sit down and clear the phone it was 11pm same time my shift finished

I'm giving you advice for free, chest beating and throwing your weight around including going to the DON because you don't like how long it takes to answer the phone is not going to win you any friends in your loved ones current facility or no matter how many facilities you move them to. 

Clinical nursing care will take precendence every time. 

Specializes in Geriatrics.

Thank you Tenebrae. I tried for a civil answer to that but couldn't do it. I would of been kicked out of here. LOL

Specializes in Dialysis.
TsalibaRN said:

They wouldn't have had to do a CYA wellness check and waste officers time if someone answered the phones at your facility.   That's the real issue.   If I was family and I couldn't reach someone where my loved one was staying, I'd lose my effing mind.  I have had to call SNFs from the hospital and at one point had FIVE phones ringing for 20 minutes before the line went dead.  I also had the DON on speed dial so guess who got a call at her home, late?  Answer the phone. 

Since you think it's that simple, please tell all of these nurses how it's done, since apparently they don't know how and you do. I can tell by your tone that you've never worked LTC. If you had, you wouldn't have made such a comment. The staff in LTC run from the moment they get there until they leave, and are beyond understaffed. I have worked in both LTCs and hospitals, and while staffing in hospitals is lacking, it doesn't even touch understaffing at many LTCs. Many hospitals don't have anyone to answer the phone either. Should the police come if a patient family or MD thinks that you don't answer fast enough?

Specializes in Mental Health, Gerontology, Palliative.
nightwingcreations said:

Thank you Tenebrae. I tried for a civil answer to that but couldn't do it. I would of been kicked out of here. LOL

There were a few sentences I had to rewrite??

Specializes in New Critical care NP, Critical care, Med-surg, LTC.

As others have mentioned, the IV issue was protocol. Patient leaves hospital with IV in place, it's a call for welfar check with police. I'm surprised the officers weren't well aware of it. Doesn't matter the disposition, it's a safety thing.

As for the phone issue, when I was supervising in a 127 bed SNF, I would be responsible for the entire facility, in addition to being charge on the 30 bed dementia unit with one aide. That was it. I had to respond to any emergencies on the other units and hope there wasn't one simultaneously on my unit. If I was near the land line phone and it rang I would answer, or one of the 2-3 other charge nurses could answer on their unit. But was there usually someone sitting at a desk? No. Not with 3-4 nurses and 4-6 aides for 127 residents. So even if a caller reached someone, the chances that they reached the right unit was small. Not a good set up, but that's SNF staffing at its finest. 

Specializes in ER.

there's no reason at all that a nonskilled phone answering/restocking/sitter job could not be created in every SNF unit. Not answering the phone is a administration problem, not a nursing issue. 

Specializes in Psychiatry, Community, Nurse Manager, hospice.
pharmanurse11 said:
What was she thinking?!

Many of us are unaware that there are significant differences between post acute care/snf hospitals and acute care hospitals in terms of staffing, especially during the evening hours. SNFs do not have a receptionist after 6pm, which means the responsibility for buzzing visitors in and out falls on the nurse or CNA while they are still engaged in their primary duties. SNFs don't have a unit secretary in the evening so the phones may not be answered if the nurses and CNAs are tending to patients and not currently at the nurses' station.

I work the evening shift at a skilled nursing facility, and yesterday morning my patient was taken to the emergency room, and he was discharged last night. I noticed a PIV in the patient's left forearm while doing my assessment and told him that I would be removing it once med pass is completed.

Two police officers show up about an hour later at the facility to do a welfare check on my patient at the request of someone from the ER.

When I try to obtain details from the officers, they are also confused, but they do believe it has something to do with the PIV, but they do not have specific information. They leave without ever seeing my patient. As a result, I contact the hospital's emergency department.

This is what the charge nurse said to me.

During shift change, the ER nurse assigned to my patient realized she had not removed his PIV. Several attempts were made by her to speak to someone at the facility for no other reason than to inform them that she forgot to remove the PIV. When she was unsuccessful in reaching someone, a colleague of hers suggested she contact the police and request a welfare check be done. She took their advice and the rest is history.

I'm still trying to wrap my heard around this one.

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Wow, that is a bizarre decision and IMO a waste of the police resource. Also in Philly if you asked the police to do that they would laugh at you. Just wow.

Specializes in orthopedic/trauma, Informatics, diabetes.

I work inpatient and we have some nurses that think everyone works 24/7. I am a weekend nurse and the ones that don't work weekends don't realize that the weekday case manager is not on 24/7. Pharmacies are not 24/7. "Insurance authorization" is not happening on a weekend, so only is rare instances, is anyone discharging to a SNF on a weekend. Plus they think someone is supposed to answer a page within 5 min when we might have one 1st year resident on page for all services in our specialty, who is covering 80 pts AND the ED. They are going hop on that request for Tums. 

I can't believe they called the police for an IV. I am sure that it's not the 1st time that has happened 

Specializes in Dialysis.
mmc51264 said:

"Insurance authorization" is not happening on a weekend, so only is rare instances, is anyone discharging to a SNF on a weekend

Those authorizations generally happen way before the weekend, there are plenty of d/c to SNFs that happen on the weekends. It's a very regular thing. Everything else that you said is 100% spot on though

It takes about 3-4 seconds to pull an IV... I gotta agree with another commenter - pull it while you are there, it's gonna probably take more time to come back later just for this...

But as for calling the police, it's absolutely standard if you can't verify an IV was removed on DC/elopement/AMA from the ER to involve the police... If I have to call a facility about this and I can talk to a nurse (not CNA or secretary) and they say 'yup I pulled it', then I'm good... otherwise I need eyes on it to make sure it doesn't stay in - more often than not the cops will report back saying yeah he yanked it out in front of us while cussing you out (because usually the person wanted to keep it in for "reasons”). 
And even if it's a SNF, if the pt goes septic because it stays in for 3 weeks because nobody thought to check it (let's not pretend like your SNF is fully staffed, you don't even have someone to answer the phone…), it's gonna blow back on the responsible ER nurse as much as it is on the SNF staff...

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