I have to agree with ruff. Basing on NH nurses isn't always the answer. The facility I work has mostly BSN nurses so we aren't idiots. I have fought time and again on the phone with doctors when they just want to send a patient out for no good reason, but ultimately, I have to listen to that physician. If they give the order for the resident to be sent out then we have to send them. An example: I call physician to get haldol orders for a combative patient. This is common for the patient and the regular doc has decided to just rely on on-call for orders when they get like this instead of a standing prn order for IM haldol. I get some random on-call doc who was not with the program and refused to order IM haldol and told me to send the patient to the ER emergent for altered mental status. I tried to get different orders, but ultimately I had to send this guy out. It sucked. I called the ER and talked with the charge nurse and explained the situation, patient rolled in combative, ER doc gave IM haldol, wrote an order for 48 hours of IM haldol q6h and called it a night sending the much calmer patient back to us within an hour. We have a great relationship with our local EMS and ER's so this worked out.
I know my facility isn't like most LTC facilities though as we have PICC lines placed and have several patients on vents, but sometimes it isn't on the nursing staff.