SNFs dumping patients...

[VentMedic]

Actually, yes I have had many nurses sit there and file there nails or talk to there baby daddies while one of there patients is in respiratory distress.

I have ahad a patient where the pt's roomate gave me a more thorough report then the nurse. Then when youa sk for report you get the "Im not from this floor" or "I dont know the patient" excuse.

Doesn't EMS stand for Earn Money Sleeping? Or EMTs: Earn Money To Sleep? Don't go there when you know there are some in EMS who consider 1 call in 24 hours too many and complain about it the whole time. I've read several of your other posts on this forum and you attitude toward nursing displays you have a sincere dislike for the profession.

Unless your own backyard is perfect, careful what you say. The blunders and laziness of some in EMS could fill the memory on the best computers.

Sorry spenac. Just read too many of his posts.

[Arizonaffcep]

I'm sorry if this stirs the pot, as that's not what is intended.

First-In my experience, there are good and bad SNF's. Some big ones are good-you get in, they know their patients (and occasionally, other RN's patients). It is clean, there is not the overwhelming stench of feces and urine. I enjoy going to those.

Then-there are those that aren't. There is one place on the east side of Tucson we call (with all due affection) "Human Stables." :roll: No joke...the RN's there can be (unprovoked) RUDE, with a near complete lack of empathy for the patients. The most attractive thing about it though...you are greeted by a wall of brown-and an overwhelming stench of feces and urine. I have even been told I can't look at the transfer paperwork, that it's a HIPAA violation, and yet their report consisted of "just take him." These...I don't like.

Most of the time, if the staff is curtious, I don't even mind if they really don't give me a report. I just read the paperwork (sometime, if I'm feeling frogy, I'll open the sealed envelope in front of the "you can't read it" RN/CNA/Whatever).

What gets me is when we go for difficulty breathing, AMS, whatever (cause you know...I was dreaming of some good lookin gal doing something...) at 0200, code 2 (normal traffic). Of course, when you get there, the RN says "I really don't know this PT" (I would assume shift change was several hours ago, and I know they don't have the same turn-over as an ED, so also assuming the patients haven't changed). Then...she says that (insert problem here) as been going on for 6 hours. You get there, the patients guppy-breathing, with a POx in the oh 70's, with cyanosis, etc etc etc. I have several problems here...first...shows an inability to assess Pt's. Why wait 6 hours to call for transport? Why code 2-clearly this Pt is CTD? Second, why doesn't the RN know his/her patients? In the ED, we are MANDATED to give report to the on coming shift. Is this not true in a SNF? --This is the type of situation that gets me kinda upset. The first thing that comes to my mind on THIS type of situation is neglect.

Now...on the ED side of things, it is kinda, well irritating that--this did just happen not 3 days ago--a SNF called for a transport to the ED because, as part of his NORMAL dementia, he got up and wandered off. He came back and they sent him to the ED because they "didn't have room for him in the higher acuity unit." WTF?!?!?! Truly-I swear I'm not making that up. He sat in hallway 4 until we could find a different SNF for him to go to. This situation--totally, unequivicly unacceptable. What about the elderly female Pt with a foley cath, who has a UTI, but is NOT septic? They (a couple of SNF's in the area, not good ones) will send these out. Bad RN's in this case? No. Lazy Dr. who doesn't want to do an assessment and prescribe antibiotics...leave it to the ED! We can solve everything :twisted: This is what gets me about SOME SNF's. To lump all together as "bad" is profiling...and that's WRONG!

But Vent, you must admit, there are SOME out there that are NSNFs (non-skilled nursing facilities).

[spenac]

To lump all together as "bad" is profiling...and that's WRONG!

But Vent, you must admit, there are SOME out there that are NSNFs (non-skilled nursing facilities).

Ron White that theres funny I don't care who you are. OK enough blue comedy tour.

I agree though there are some bad nursing homes, when my grandmother got to where she needed 24 care we started looking and some nursing homes are just disgusting. Might have 1 nurse or nurses aid per 20-30 patients. Then we found one that almost seemed to have more nurses or nurses aids than patients. Very clean, did not stink of urine/feces or air freshener to cover stench. They had bird cages, fish tanks, cats and dogs in the inner court yard, food was excellent. Mind you these were us just popping in, we did not call first. Now the problem, cost per month was way above what Grandmothers social security and medicare covered. Well we found away and she lived very happy life there for several years. One of us visited almost every day and she was always well taken care of. Now move forward several years since she died and a big company bought ought the nursing home. Now it is one of the filthiest. In fact it barely was allowed to remain open after last inspection.

What can we do? Be there for the patients. Its sad that the facilitys that are bad stay around. But its even sadder that often no family ever comes and checks on their elderly family members. If I would have ever found grandmother in the state I have found several patients, there would have been heads rolling then and there.

OK so it's agreed there are scum nursing homes, scum doctors, scum nurses, scum paramedics, scum fire fighters, scum hospitals, scum vent techs :twisted: , and there are some good ones to of all the above.

[xgldcrossemt]

Has anyone in this forum worked in a SNF? If not, how can you nitpick how situations are handled. Most EMT's and Medics have no idea of the day to day operations of an SNF any more than the LPN understands life on the street. They probably view EMT's as lazy, and just it around all day and wait for calls. I have worked in both environments, and I would give this advice: Try to see beyond your own nose.

[Arizonaffcep]

Has anyone in this forum worked in a SNF? If not, how can you nitpick how situations are handled. Most EMT's and Medics have no idea of the day to day operations of an SNF any more than the LPN understands life on the street. They probably view EMT's as lazy, and just it around all day and wait for calls. I have worked in both environments, and I would give this advice: Try to see beyond your own nose.

Can't...no glasses!

[defib_wizard]

Okay my turn at seeing who I can tick off! I agree that the staff at a snf has a difficult job to do. Taking care of the daily needs of one person is a burden. Taking care of a whole facility is an almost impossible task. From what I see the people that spend the most time with the " residents " are the cna's . While the nurse is trying to stay on top of administering daily medications and documenting that it was done. This amounts to maybe less than 10 minutes per pt per shift. So it comes down to the least common denominator the cna, who has the least amount of education. If there is a problem they have to find the nurse and have them come assess the pt. Who then has to call the doctor to decide if the pt should be transported or not. If he wants some things done like tylenol for fever or an enema for constipation, if these don't work then ems is called.

Once we arrive we should be given a verbal report, and a med list with hx and allergies listed. This is not a hippa violation this is a continuity of care! Also code status is a helpful document as well.

I have seen some competent and outstanding nurses in snf's and some that i wouldn't let care for a stray dog. However I can name plenty of ems providers that I can say the same thing about.

What I started to post was a description of some of the stupid things I have seen over the years from snf staff. I changed my mind and tried to be objective because I've seen some pretty stupid thing done by ems as well. Sometimes even by me ( hey I'm human ).

Ems is caught in the middle when a snf transfers a pt to the er and the er is not happy. Then transfers them back and hasn't done anything the snf nurse thought should have been done. So it can be difficult to maintain a professional attitude when all you hear is bitching. Including from your coworkers.

[VentMedic]

While the nurse is trying to stay on top of administering daily medications and documenting that it was done. This amounts to maybe less than 10 minutes per pt per shift.

10 minutes per patient for both documenting and giving medications per shift?

It takes some EMTs and Paramedics 30 - 45 minutes to document one page on just one patient. The RN also does wound assessment documentation and still must do other written assessments as well as charting for phone calls to the MD and family.

NH and SNF patients are usually incapacitated and can not line up at the medicine cart. Many of their medications must be crushed or mixed into some "takeable" form. They can't just force feed 10 - 15 pills down a patient's throat even if the patient is able to swallow fairly well. Even an MD inhaler if done correctly can take 5 minutes. If they have 3 that may take 6 - 10 minutes with just the respiratory meds. Meds also include those for wounds. Dressing changes can take awhile. Vitals are also required and must be documented before giving a med. Some RNs may take their own vitals especially if more than one hour has lapsed since the CNA did rounds. Then, there are IV checks and starts. The list goes on.

Even if we used your example of 10 minutes per patient for just meds, at 20 patients, that is 200 minutes. There must still be dressing changes and assessments. Then, you have the constant flow of interruptions by family and transports/transfers with all demanding information RIGHT NOW! Often the RN will play nurse, family counselor, secretary, ward clerk and still must find time to stroke the egos of EMS or the nurse will be greeted with a stream of verbal abuse that would get any other professional (excluding MDs) fired. If they complain to the EMS company, often they are told how stressful these routine transfers are for the EMTs and Paramedics. I would hate to see some of these EMT(P)s handle a real emergency if the NH calls stress them. Oh wait, I have seen these same EMT(P)s muck up emergency calls and stress out on them also.

Again, the nurses do not have a full lab or a crystal ball to tell all about the patient. If the nurse doesn't send the patient and the patient decompensates rapidly, the family, MD, ED staff and EMS will bitch about not sending sooner. If the patient is sent early the only ones that might bitch are the ED staff and EMS. Yes, the ED staff gets annoyed because many there may feel they are Trauma surgeons and Trauma nurses just like those in EMS. This "clinic" calls are beneath them. Geriatric medicine is not for everyone. And, some ED doctors and RNs enjoy doing their jobs and giving the patient a thorough assessment. Some (EMS and ED) get hung up on the DNR status and forget it doesn't mean Do Not Treat. Ever wonder why there are not more DNRs on patients in NHs? The admitting MDs feel their patients will never get treated or treated as well as a patient that is full code. But, they may have made a notation to be called if death is imminent or before life support is initiated.

defib_wizard

Ems is caught in the middle when a snf transfers a pt to the er and the er is not happy.

Patients are the ones caught in the middle. How does it affect YOUR life one way or another as to what happens to this patient? You are paid by the hour. You probably won't remember the patient's name even after riding with the patient to the hospital and must look at the paper work to introduce the patient at the ED. Often, a name is never given. All you're going to remember about the patient is "some stupid nurse BS call".

Some people have a choice and can shop for a NH or SNF. Usually it is dictated by insurance and availability. Unfortunately people can not determine who their ambulance or EMS EMT(P)s will be. It is unfortunate in some areas of crappy EMS/ambulance and bad attitudes, usually go hand in hand, that there aren't better alternatives for transport for the disabled and elderly. It would be nice to have a company staffed by healthcare professionals that understood medicine and the American healthcare system.

Unless you have proof there is blatant fraud, neglect or negligence occuring at these facilities and then have the ambition to follow through, there is not point in bitching about it. Just be professional. Too much bitching just makes you look unprofessional and uneducated. Your crappy attitude will be reflected in your work whether you believe it or not. The same can be said for some ED staff when they no longer feel sick old and disabled people should be cluttering up their hallways. Their preference may be for the SNF RNs not to do their job or be concerned so the patient will just be a quick code and off to the morgue. No remembrance of the name or even the code later.

[Richard B the EMT]

I will disagree on one point here. When the facility and ER nurses vent on how ineffectual the others are, as we, the ambulance crews are right there in front of them, they both show THEIR unprofessionalism by venting at us.

So perhaps it is BOTH the patients and us caught in the middle. The patients usually don't know or understand that the venting is going on, and it behooves US to maintain OUR professionalism when and if it happens to us.