Nursing Homes - Your general experience?

[cotjockey]

I work in a NH and I honestly have horrible experiences almost every time I respond to a 911 at one (the one I work at isn't in our fire/rescue district, so I never have to go there). I know that the nurses' hands are tied as far as giving more O2, splinting, some dressings, etc...they just don't have the supplies or the doctor won't give orders since 911 is supposed to be en route. Also with limited staffing, it can be really hard to get paperwork done in the brief time between getting orders to transport, calling 911, and arrival of the ambulance. We've managed to remedy the paperwork problem by having ready made transfer sheets with appropriate names, addresses, and phone numbers, med lists, treatment lists, and diagnosis sheets...we up date them once a month and are ready to go at any time..just have to pull them out of a book.

There is NO excuse for not knowing at least a little bit about the residents you care for...if the nurse doesn't know because she is new or whatever, there should always be someone they can ask. There should always be a chart available with a summary of the resident's mental status, habits, abilities, etc (we do them monthly and PRN when there are significant changes). Nurses need to take time to figure out important information about the people they are caring for.

It really frustrates me when I show up as a paramedic and still have the nurse trying to direct care...she called 911 because there was something going on that could not be handled in the nursing home...once we are there, it is time to back off and let us do our job. I think it would make me very uneasy if I were the resident and had a bunch of strangers (EMS) trying to put O2 on me while the nurse (who has been caring for me for years) stands in the background yelling "Don't do that, he has COPD!" Who do you think the resident is going to trust more?

I always want to go to all of the NHs we respond to and do an in-service on how they can best help us when we show up and explain some of the logic in what we do...our rescue captain doesn't think it's a good idea. She thinks we just need to show up and do our jobs and leave things as they are...no need to hurt feelings or make people feel bad...I don't totally disagree with her, but...

It would be nice to just let them know what kind of training we have, what our scopes of practice are, how our protocols work, how they can help us by having someone to show us where the patient is, clearing obstacles out of the way, giving us a little background, etc...it would be nice to feel like we are all on the same team instead of them feeling like we are a bunch of idiots showing up for the adrenaline and us feeling like they are a bunch of incompetent nurses who can't cut it anywhere else. I've been on both sides, and I know a lot of times, those feelings are there. I think it would help if we all knew a little more about what the other ones do.

[itku2er]

Ok I will ask any of you that have doubts about a NH and that there are good ones come to VA and visit the one i work at...I Would love to show you all how we do it here and How I do my job as a nurse ........invitation is open to anyone that might like to do it.......just let me know........especially GODFATHER .......... :roll: :roll: :roll: :roll:

[Yummymedic05]

Terri I know you are a wonderful nurse, but havne't you ever gotten called to a NH while working on an ambulance and had a not so nice experience with another nurse?

We have one NH nurse that calls 911 and states its a full arrest, only for us to get there and Ethel stubbed her toe. That nurses laughs and tells us each and every time she does this that it amuses her that we get there so much quicker...

Another NH we go to is wonderful, nurses who know what's going on. give awsome reports, help you move the patients, etc. We get called for a fall, upon arrival this patient had been moved into her bed and the nurses were cleaning her up and talking to her. This patient was dead...these nurses had no clue....

Honestly I would rather deal with the worst nursing home nurse than have to deal with our VA 'doctors'!

[Just Plain Ruff]

Yummy, I'd have that nurse up on charges for 911 abuse. That is a true example of 911 abuse.

[thbarnes]

I can't forget the dozens of times I've picked up a nursing home patient for private transfer and while flipping through their paperwork in the back of my truck getting their information for my report, I see that they're positive for MDRTB (multidrug resistant TB) and/or MRSA. I love it that they aren't on isolation in the nursing home, no one told us they had TB or MRSA (if they told us anything at all...'they're not my patient'), and now I have to file exposure paperwork, get another PPD test on my day off, drive back to the doctors office to get it read, and hope for the best.

So much for The Ryan White CARE Act.

[buckeyedoc]

Terri I know you are a wonderful nurse, but havne't you ever gotten called to a NH while working on an ambulance and had a not so nice experience with another nurse?

We have one NH nurse that calls 911 and states its a full arrest, only for us to get there and Ethel stubbed her toe. That nurses laughs and tells us each and every time she does this that it amuses her that we get there so much quicker...

Another NH we go to is wonderful, nurses who know what's going on. give awsome reports, help you move the patients, etc. We get called for a fall, upon arrival this patient had been moved into her bed and the nurses were cleaning her up and talking to her. This patient was dead...these nurses had no clue....

Honestly I would rather deal with the worst nursing home nurse than have to deal with our VA 'doctors'![/quote]

AMEN to that.

It's been a couple of years ago, but we had a nursing home that would call 911 and a couple of private squads to see who would get there faster. We happened to be there dropping off a patient when the nurse comes in and says that a patient is coding and is a full code. We run back out to the medic and grab our gear just as the FD is rolling in. We get into the the room and do our gig and the FD walks in and has a total sh*t fit. We actually worked the code w/ the FD and it went smoother than I could ever imagine. The asst. chief of the FD goes back in and eats cornflakes out of this nurses' skull.

[stcommodore]

I think when all things are equal it would only be fair for a nursing home nurse to provide a breif report to the EMS crew. I honestly don't care if your busy, have three other patients, etc. Clearly this is supose to be an "emergency" so you can at least provide that report and there paperwork. Everyone has there bad days both NH staff and EMS crew but we are all in it for the patient so for there sake I wish things were better.

[strippel]

We have the second largest nursing complex on the east coast. It is very expensive, and the care is usually great. More often than not, a nurse or other staff member is with the patient, and the charge nurse usually meets EMS at the elevator or desk. She then walks with you to the room, after handing over the paperwork, giving a short report, and answering questions. Most of the time, things are wonderful. And for the price the people are paying to be there, they should be.

They also have a plan where independent residents (volunteers called "minute men") will stand at doors and elevators, let you in, and give you directions during emergencies. These old timers are great. But, sometimes the staff slips.

We also have some of the crappiest places I have ever seen, and I wouldn't let my worst enemy's dead dog stay there. And they are part of national ECF chains. One place, has a nurse who can't speak English. Nothing. My partner and I can't understand her, the patient and their family can't understand her. How can her co-workers or 911? She arrives with the paperwork, and then leaves rapidly. Last time, luckily the family was with the patient, and gave me all the info I needed, and was very kind to us.

[Medic6698]

Cotjockey has it right. Instead of us all sitting here pointing the finger at who is at fault and who is "God", we should take our experiences to management and suggest that we all sit down with the DON, various administrators and personnel of the homes you service and explain what our training is, how the protocols work, what we are looking for from the staff and what problems we are having etc. We did this at the service I work for and unfortunately, we had a piss poor turn out on the part of the home. But it is all about the communication. And once those communication channels are open, you can do other things like pre plan and train for that disaster, fire or power outage.

We (RN's, medics, EMT's) are all here for the same purpose. The money (j/k) We are here for the patient. And yes, as with everything in life, there are two extremes and the gray area in between. Some people are just horrible caregivers and others have the God mentality. But that's for their boss's to sort out.

[cotjockey]

I think it would help a lot to know more about what the nursing homes do too. A lot of my coworkers don't understand that they don't have access to high flow O2 or splints or dressings other than 4x4s and ABDs...they also don't understand that the nurses there can't put on O2 without an order or give D50 without an order or start IV fluids. Also, a lot of times our residents don't tell us they aren't feeling well until they are REALLY not feeling well...we don't check vital signs and do head to toe assessments every shift (or more) like they do in the hospital. The nursing home is supposed to be a HOME, not a hospital. Most of us try to keep a good eye on our residents...sometimes we can tell when something is going on by their behavior (we have a lady who stops eating when she has a UTI...another who gets confused when her B/P is high), but too often if something gets missed is it because there are no outward signs and the resident doesn't say anything to us.

But again there is NO excuse for not providing at least a brief report and letting EMS know that normally the resident is alert or confused or that she doesn't have feeling below her waist...I have never worked on a unit where there isn't at least one staff member who has been there a while. Even when I have done agency nursing, I knew who was confused, combative, independent, etc...I usually had to ask, but I knew.