Firefighter vs. Nursing Home

[DartmouthDave]

Hello,

Picking on a long term care facilities is too easy. Mainly due to horrible patient-to-staff ratios and inadequate staffing mixes (RN/LPN/NA). They never can shine.

Personally, working long term care is a horrible job. I couldn't do it.

David

[Siffaliss]

Hello,

Picking on a long term care facilities is too easy. Mainly due to horrible patient-to-staff ratios and inadequate staffing mixes (RN/LPN/NA). They never can shine.

Personally, working long term care is a horrible job. I couldn't do it.

David

I agree in so many ways ...

[Eydawn]

LTC facilities are definitely a challenge, I can safely say, as I'm sitting here on graveyard shift at an assisted living. There are many that provide good care, if not excellent care... I would second what Dave said, though, as far as staffing inadequacies and weird mixes of levels. Now that I work in this setting, I totally see where some of the LTC stuff comes from as far as why we didn't call sooner, what we didn't do, etc. The honest to God truth is that LTC facilities attempt to care for problems until it becomes WAY out of their capacity (which is part of what they're supposed to do), OR, problems just honestly get missed/overlooked. It's not intentional neglect, as far as I can tell- it's mainly that the nursing staff is overworked and simply doesn't remember everything reported to them by the care providers/CNA's over the course of a shift.

I had to report someone's SOB with exertion and increasing pedal edema about 5 times over the course of 1.5 weeks before he finally went to the doctor. Surprise- nurses got fired in between his doctor visit and results being faxed back, and it took another week before folks realized that he had been diagnosed with CHF. The BIGGEST challenge to providing good care is consistent communication. Where EMS only has to get the basic history info and acute history and treat the patient for ~ 1hr at most, LTC facilities provide care for weeks, months, or even years. Try getting every nuance observed over your shift communicated to the next shift, and have them communicate that in turn to the shift after that... it's like a giant game of "Telephone" and so you have to be vigilant in your documentation and reporting to make sure important stuff doesn't fall through the cracks.

Then there's the issue of how good your nursing staff is... we had a few LPN-FAIL! types and now we mostly have very good LPNs with a few pool nurses to help fill out the schedule.

I totally get why it's frustrating from both sides and why LTC facilities and EMS don't always play well together- they're coming from different worlds, and sometimes EMS sucks and sometimes the LTC facility sucks. Throw some egos and misunderstanding of what the medical purpose of your given role is in there, and you've got a grade A cluster!

Just my rambling...

Wendy

CO EMT-B

[HellsBells]

My real problem with these LTC facilities are the facility Doctors that seem to be chronically absent, or advise that a patient be sent to the ER after a phone "consultation."

Otherwise, the video is really funny, even if the lego guy is a fire fighter.

[EMS49393]

This happened to me last night, except I was the paramedic, not the fire fighter, and the nurse was only a CNA. Oh, and I didn't curse, but I wanted to.

I'm glad the facility called me, because after I arrived there was one person in the room that could figure out what was actually going on. Just because a patient is often "pleasantly confused" doesn't mean they are lying to you when they tell you they are in pain. Especially when the painful extremity is twice the size it should be and inflamed to the point that it might spontaneously ignite. "She's altered, she keeps screaming Help Me!." She's not altered, in fact if she's screaming "help me" she's probably less confused then you might think. I'd be screaming that as well if I had to live here.

Edited January 15, 2010 by EMS49393

[Kiwiology]

Love it, they need to show the two fire trucks rolling up and eight guys in all thier getup barrelling thru the door with the almighty "everything is ok, highly trained professional Firefighters are on scene now!" look.

.... cut to six guys standing around doing nothing, one doing a blood pressure and the other talking to the two cops who have shown up.

[fireflymedic]

Well, I used to just excuse it as they were incredibly poorly staffed and doctors that worked there were morons. I talked to a few nurses in the local nursing home after making more than a few idiotic runs and asked them what their problem was - why the doctors were never around. I was told "we function under nursing judgement - the docs aren't ever here, so if we see signs of something we go ahead and treat it" - hmmm is that why a pt functions with a UTI for a week until he becomes septic you don't have the judgement to determine that he needs a UA ? I was excusing it before that they couldn't do anything, now I realize it's they wouldn't do anything - they were flat lazy. She didn't realize she was just making herself look worse.

Now before I'm jumped, yes I understand that not all nursing home nurses are bad, but considering in most it's LPN/LVN's that have charge capacity and not the more experienced RN's (sorry honey, that's not a rhythm - those are pacer spikes), and many (not all, but many) are unwilling to take the intiative to take care of the residents properly, then I can see where videos such as this and opinions that are prevalent are formed.

[chbare]

I got a kick out of the fire fighter bragging about intubation. The "I can do more skills than you" discussion comes up from time to time and I found the notion rather funny.

Take care,

chbare.

[Richard B the EMT]

Way back in the day, I used to have regular midnight IFTs from a place to the ER a short distance away. The ER staff would do it's job, and send them back to the sending facility.

ER Nurses: "What is wrong with those nurses at that facility, this is something they should be able to handle without transferring the patient to us?"

Facility Nurses: "What is wrong with those nurses at that ER, can't they see this patient is SICK?"

Me: I said nothing. As already indicated, I like remaining gainfully employed, which if I had commented as "LeggoMan Fire Fighter/Paramedic" did, I shortly thereafter would not have been.

[fireflymedic]

Meh, if I'm going to submit to watching FF videos, I'm at least going to amuse myself. I prefered this one over lego man

http://www.youtube.com/watch?v=sbnAcCzTxk4&feature=related