Why does nursing home care vary by size of city?

[boeingb13]

why is it that when you live in bigger cities, the care in nursing homes and hospitals, is so bad, they go through the same training people in small towns do.

Title edited to reflect content...AK

[johnbasic]

I dont know were u are at, but up here NH all nursing homes SUX they dont beleive in calling 911 for pts that need to get to the hospatil a/s/p but they dont like the fact that if they do call they gett he fire trks and the ambos so yea its noting new. Most RN are burned out er rns ive seen

[VentMedic]

why is it that when you live in bigger cities, the care in nursing homes and hospitals, is so bad, they go through the same training people in small towns do.

Ask the RNs, LVNs and CNAs how many patients they each are overseeing. In many NHs, the RNs or LVNs may be responsible for more than 25 patients. 15 is the usual number. One CNA may have 20+ patients. And yes, in many states this is legal. Even California, the nurse:patient ratio is low for the acute setting as mandated by law, but can be quite high in the extended care areas.

There is a big difference from the 1:1 patient to EMT ratio. Or, actually, it is 2 EMTs for 1 patient.

[emt322632]

I live in NY, used to run for a private service where we did lots of NH runs. A story I never tire of telling (mostly to EMT-B students who I threaten with bodily harm if they EVER do anything like this) occurred when we got dispatched to a 70 y.o. male unconcious/unresponsive

We get there, hx of diabetes...they said they checked his sugar and it was 40, so they gave him some sugar...

oral glucose...3 tubes...on a patient who was UNCONSCIOUS!!! Let me tell you, that stuff is hard to suction...

Another story involved a call to the same home for a pt with low Spo2...we get there, pt is in no obvious distress, just lying in bed, wondering what the heck is going on...his SpO2 was around 93%...he was on 2lpm...we upped it to 4lpm, and what do you know, his SpO2 increased to about 96%...

Took him to the hospital...then about 30 minutes later took him back to the home...another 30 minutes later we got called back to the home again for the same man, low SpO2...again, we did the same thing...The ER doc said she was convinced they didn't know what they were doing...so was I...

There are some good nurses in nursing homes, but unfortunately it's the bad ones that stick out...

[JPINFV]

why is it that when you live in bigger cities, the care in nursing homes and hospitals, is so bad, they go through the same training people in small towns do.

Why is it that 2/3s of the posts that you've made have been about nursing homes? Sure, I've seen my fair share of stupid nursing home stunts, but variety [of topics] is the spice of life.

[Richard B the EMT]

On the "big city" side, perhaps there is some truth here:

Call comes in as a cardiac arrest, the CFR engine, BLS ambulance, and ALS ambulance respond.

On arrival, find the patient's room is at the far end of the corridor. Staff member flags us from the door and enters the room. Crews arrive in room to find staff members doing CPR, not sweated up, looking neat. As crews take over CPR, states that the patient was talking with them "5 minutes ago".

Crews not looking neat less than 2 minutes into CPR, on a patient that has rigor mortis and dependant lividity. Crews now extremely sweated out. CPR and meds continues for 10 minutes as senior Paramedic calls Medical Control for authorization to discontinue CPR, approved. Leave body with PD.

1) Is the person flagging the crew from the room door the lookout to tell the staff members already in the room to "start CPR, the crews are here"?

2) If the patient was talking 5 minutes ago, was it a 2 person conversation, or the staffer talking and not getting an answer?

2A) Never ask staff if the patient was talking back to them. If you ask, you know the chief nurse will be calling in a complaint before you get the ambulances out of the facility driveway.

3) Just as the crews are leaving, someone will always find the DNR paperwork.

I'll say every service has some facility in their area where some, if not all of this, goes on.

[epi-do]

Crews not looking neat less than 2 minutes into CPR, on a patient that has rigor mortis and dependant lividity. Crews now extremely sweated out. CPR and meds continues for 10 minutes as senior Paramedic calls Medical Control for authorization to discontinue CPR, approved. Leave body with PD.

Ok, just curious, but why was this patient even being worked in the first place? If they have rigor and lividity present, isn't it safe to say they have been dead for quite some time, despite the nurse insisting they were talking "5 minutes ago".

[Richard B the EMT]

The CFR Engine, BLS and ALS ambulance crews follow a simple credo: If someone starts CPR, CPR will be continued until physically unable to continue, higher medical authority (Medical control) tells you to stop, or Spontaneous Return Of Pulse/Circulation.

Why the staff starts? No clue.

[wildernessmedic1]

I think that in smaller towns, the nurses may know their pt and want to treat them with a little more respect than they would in a big city.