Why do Con home nurses do this

[tskstorm]

Excellent point. Why not move on?

This is just like a relationship. If it's bad, do you just accept the bad? Do you try to change that person? Do you turn gay? Or do you move on and find somebody you are more compatible with?

We have choices. Use yours wisely.

Got to love when Dust agrees with you, its a lot easier then when he disagrees.

+5 for me

[NYC-EMS]

Were you mistaken?Was it really a nurse?I think you ran into the dreaded N.A (nurses assistant)They are the new nursing home plague.

[Dustdevil]

Were you mistaken?Was it really a nurse?I think you ran into the dreaded N.A (nurses assistant)They are the new nursing home plague.

And then there are all those "Patient Care Assistants" who couldn't be arsed with 'all that book learnin' to become a CNA. :roll:

They all whine about not being payed as well as Real Nurses, just like EMTs do.

[ladyemt51_2000]

Wendy,

I belong to this support group online: http://alzheimers.infopop.cc/eve?s=387101241

Great group of people who offer a lot of support to caregivers with loved ones dealing with AD. I know your Mom is in a NH but you are STILL a caregiver to her. AD is such a horrible disease and I feel for you for what you and your Mom are going through. Take care.

[Bombera]

OMG! We go on atleast one call a day for diff. breathing and you find an elderly patient gasping for air with retractions and all and if the patient has been particularly lucky, you will find them on O2 at 2lpm via n/c supine in bed! The other thing that you will sometimes find is a person who is clearly in hypovolemic shock due to a GI bleed or what have you and they have waited 5 hours to call EMS and then they don't even call 911, they call our damn non-emergency BLS service. What the hell is wrong with these nurses?

Call to top all horrible calls...we respond to a con home for a poss. CVA. Pt was found 2 hours ago without the ability to speak or move half of her body when she is normally both active and verbal. When did they decide to call EMS? After she remained that way for 2 hours! Needless to say, we called medics and they ended up taking her. I was so pissed off that they didn't call 911 in the first place that I said something to the lady that I thought was a nurse a low and behold she wasn't and not only that, but she had been ordered not to call 911 for this pt because the pt was on hospice. The pt only had a DNR refusing compressions! The lady that I talked to was actually upset because she knew that she needed to call 911, but she would have had to risk her job for disobeying direct orders. That's one job that I would have risked. Anyway, my partner and I are in the process of writing the con home up since this pt only had a DNR prohibiting compressions.

Anyway, when any of my family gets old, they are going to my country to get cared for because they will not be cared for here in a con home!

[Dustdevil]

Needless to say, we called medics and they ended up taking her.

I think it needs to be said; why did you call medics instead of just transporting her ASAP?

Anyway, when any of my family gets old, they are going to my country to get cared for...

Yeah, I think that's what my dad did for my dog when he got old. My dad says he took him to a good family out in the "country," where they would love him and had lots of other dogs that he could play with.

[akflightmedic]

Thank you Dust. That was so damn funny, I busted out in a good ol belly laugh for a couple minutes. Sure put a smile on my face.

Man I love it!!!

[VentMedic]

OMG!

When did they decide to call EMS? After she remained that way for 2 hours! Needless to say, we called medics and they ended up taking her. I was so pissed off that they didn't call 911 in the first place that I said something to the lady that I thought was a nurse a low and behold she wasn't and not only that, but she had been ordered not to call 911 for this pt because the pt was on hospice. The pt only had a DNR refusing compressions! The lady that I talked to was actually upset because she knew that she needed to call 911, but she would have had to risk her job for disobeying direct orders. That's one job that I would have risked. Anyway, my partner and I are in the process of writing the con home up since this pt only had a DNR prohibiting compressions.

You just brought up a good point. Some EMS crews are also quilty of not reading the DNR carefully. The EMS crews usually just ask when entering the Nursing Home if the pt is a DNR and they will just hear DNR. Some also don't realize that hospice does not alway mean DNR. In some States the patients are given the option of signing a DNR or limited DNR. There are also stipulations for Medicare/insurance to pay for other medical care that may or may not be related to the terminal illness thus the Hospice care has to be revoked just for the duration of that hospital trip. Some hospice organizations that specialize in HIV/AIDS have special contracts that allow their patients to remain a Full Code in order to get hospital treatment for other illnesses that should not necessarily be life ending. Revoking a Hospice order does not always mean some family member, caregiver or the patient had second thoughts.

There are EMTs/Paramedics that also get very upset when the hospital will put DNR patients on non-invasive ventilation and go all out short of actually coding a patient to treat CHF or PNA which sounds a lot like "death rattles". There are also some medical professionals, including those at nursing homes, that equate DNR to Do Not Treat and provide very little care including O2.

The nurses are also put in an uncomfortable situation by EMS crews. Sometimes, no matter what they do they will not be able to please their employer, the patient, the family, the BLS crew and the ALS crew. Initiating different EMS responses, ALS 911 or ALS transport or BLS transport, also require different procedures that must be followed with the doctor, insurance and hospital. If the nurse reacts one way somebody is going to play the arm chair quarterback and second guess his/her decision. There's always someone, including EMS crew members, that yells the remark "I'm reporting you and get your license taken away". Not a good position to be in for stress of constantly defending one's decisions even when you've attempted the best care under bad working conditions and poor continuing education. There may be only one licensed person in the facility. Many times the doctor is also controlling the calls but the nurse is the face you see. That is why even in the hospital settings throughout the country, a special team (Rapid Response Team) had to be initiated when the primary doctor drags his/her feet to prevent a code situation.

Yes, some nursing homes and extended care facilities leave a lot to be desired. Many are running on limited funds and are ran by owners who want more profit for their own pockets. Some nursing homes do not have piped O2 and utilize a concentrator provided by a homecare service for each O2 patient. There may only be one O2 tank available. The same with suctioning. There are some long term ventilator facilities ran like this also with LPNs (RRTs or RNs are costly) managing the ventilators and O2 concentrators supplying the ventilator FiO2. California is one state that allows this. Many facilites are not required to have much for emergency equipment/medicaton (thus 911 is called) and all medications must come from an outside pharmacy. Even the medications that you would expect to be available for some emergencies like albuterol are not available unless taken from another patient's supply. So, very little education is focused on emergency situations. This again puts the professionals in a precarious situation. The turnover is high because there is little they can do over ride the system. Sometimes they are scraping the bottom of the barrel when when comes to hiring employees. If the place has a reputation of bad working conditions, quality people do not want to jeopardize their licenses. The agencies that monitor these facilities are overburdened. Some hospitals do track the patients and their condition from facilities especially Medicare admissions that are within 30 days of each other except for scheduled visits.

The U.S. healthcare system needs some overhauling when it comes to taking care of the disabled and elderly.