Nursing Homes - Your general experience?

[JPINFV]

Sounds like your nursing homes, and mine, needs to invest in O2 (a lot here have high flow, though) and standing orders, or invest in better nurses until the doctors are willing to write these orders for them.

[psychemt123]

Sometimes it's worst working at the 9-1-1 center having to take the call. We usually get the age & sex of Pt ... ask what the problem is, etc ... usually they give me a date stating they were born ## / ## / #### - I always say -- that makes the Pt how old then? We also get PMH for responders and they tell us, oh I don't know - the doctor just wants us to send him/her out ..................................

[cotjockey]

Sounds like your nursing homes, and mine, needs to invest in O2 (a lot here have high flow, though) and standing orders, or invest in better nurses until the doctors are willing to write these orders for them.

I'm not sure what you mean by "better nurses." We have some really good nurses at the NH I work in...however, we are limited by lack of resources, scope of practice, state regulations, etc. Personally, I am willing to treat residents emergently as far as my resources will let me...I have no problem putting on O2 or increasing O2 or whatever. I won't however do anything invasive, like an IV without an order...in the first place I am an LPN and LPNs here don't do IVs without taking an extra semester long class...my facility doesn't allow LPNs to do IVs anyway. Sure, I can do all IVs when I am not at work, because then I am a paramedic, but I have to stay within my LPN scope of practice when I am on the clock.

It takes a pretty good nurse to recognize that something is up with a resident when they say they feel fine, their vital signs are normal, and their symptoms are as subtle as refusing breakfast once...

[JPINFV]

Most of the SNFs I encouter locally are really bad. By better nurses, I mean an actual report for my patients. I mean being able to correctly triage full code patients (i.e. that patient with rales at the door, ALOC, diff. breathing, and almost no BP (UTO, ~40/30 via machine at the hospital after first round of dopamine) is not a BLS patient, and properly monitor a patient during an event (i.e. the patient tugging on her PVAD enough to loosen it shouldn't be left alone so that she can completely remove it). As I said earlier, putting infected patients with non-infected patients is not a good idea. Finally, I expect that SNF nurses (at any level, the life guards at my water park get taught this) to be able to correctly use a NC or NRB (especially in terms of flow rate).

I understand the problem with ALS procedures (again, if within your scope, shouldn't you have standing orders for emergencies?), but most of the problems I see are simple administrative problems (when to request transfer to the ER, correct use of BLS vs ALS ambulances, room placement) and not really about independently treating a patient. With these problems, it is very understandable to not have standing orders.

That said, a local problem is the lack of private ALS services (RN-CCT: yes. EMT-P: No). There are plenty of patients that aren't really stable enough for BLS, but aren't critical enough to activate the 911 system, but I'm not talking about those patients.

[Lithium]

I've often wondered if RNs and RPNs often complain about their experiences to each other with the most recent EMS personnel to show up for their 9-1-1 call. I'm sure this isn't a one-way street, but it would be nice to know what the 'other side' has to say about us ...

[cotjockey]

I've often wondered if RNs and RPNs often complain about their experiences to each other with the most recent EMS personnel to show up for their 9-1-1 call. I'm sure this isn't a one-way street, but it would be nice to know what the 'other side' has to say about us ...

Nurses bash us quite a bit...LOL. Sometime when you're bored, check out allnurses.com...do a quick search for paramedic and you'll get quite an education...

[medic001918]

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.

I have no problem with something not being done because you don't have the order. But I also shouldn't have to explain to nursing home staff why a NRB at 6LPM isn't an acceptable delivery device that can actually make the patients problem worse. If they don't have access to high flow O2, then don't use a high flow device. Use the appropriate device.

Shane

NREMT-P

[itku2er]

Sounds like your nursing homes, and mine, needs to invest in O2 (a lot here have high flow, though) and standing orders, or invest in better nurses until the doctors are willing to write these orders for them.

why not get rid of all nursing homes and let people take care of their families at home the way it should be? Instead of putting them in nursing homes for US to take care of and YOU to have to come pick up? Seems to me that this whole problem could be solved if people would just take care of their own at home........but oh wait......then that would mean that people would actually have to have a heart and show love and compassion for some one besides their selves wouldnt it? oh silly me to think that would actually happen :roll: :roll: :roll:

[Yummymedic05]

:cheers: :thumbup:

[cotjockey]

I have no problem with something not being done because you don't have the order. But I also shouldn't have to explain to nursing home staff why a NRB at 6LPM isn't an acceptable delivery device that can actually make the patients problem worse. If they don't have access to high flow O2, then don't use a high flow device. Use the appropriate device.

Shane

NREMT-P

Amen to that!

:wav: