SNFs dumping patients...

[Laura Anne]

>>> walks over to Ventmedic with a big smile on my face, GENTLY reaches out and starts to massage Vents ears, all the while stating, "Vent, repeat after me.......GOOOOOOOSAAA-VAA-BAAAAAAA...."<<< :wink:

Seriously, Vent, I understand your defending the NH/SNF personnel due to the fact that you have the rare privilege of actually working with them. Your points are justified. Only problem is that w/o people being able to comprehend how it is exactly on that side of the fence, they will still defend what they know.

NOW, that being said, if people do not respect each others opinions and points of view, then you're pleading pure ignorance which in this field is LITERALLY A DEADLY GAME TO PLAY!!! Step back people and see it from each others side's w/o getting all bent. Respect and learn from each other. Thats what this site is all about.

My only thing I want to question is...... Ventmedic?????? DO RN's honestly take care of 30-50 patients in a shift or on their own? That just sounds very dangerous, for both the patients as well as the RNs and CNA....and vent peoples... 8)

[VentMedic]

I am sure when you where an RN at a LTC facility you complained about the EMS crews sometimes. Am I right? One bad apple can ruin it for all, and we need to keep in mind that the one bad apple is not representative of all in that career.

One bad apple? In EMS?

When I was a field officer, I was actually dispatched to nursing homes by the PD who wanted to arrest our guys for becoming verbally and to the point of being physically abusive to the nursing staff. The reason; the nurses weren't quick enough in getting them the paperwork. You have no idea how many people out of the many patients the RN is in charge of is pulling that RN in many directions. They have to be very careful and cautious about everything or unlike EMS which is protected by state immunity laws, they are no. Unless you want to and can do their job it is not for you as an EMT-B with 110 hours of training to 2nd guess RNs and MDs. And no, there usually is not a secretary around to copy paperwork for you. And, the RN must also get the call into the MD. And, not leave another patient hanging in the middle of some treatment in an unsafe condition. You get a lot of sick and medically needy patients under the same roof and it can be overwhelming.

It is also diffcult to crique nursing home equally because not all have the same staffing ratios or reserve staff if someone calls in sick. Many run very lean. Many LTCs facilities have different acuities and handle sicker patients.

I probably had it easy as an RRT moonlighting in a subacute with only 40 patients total compared to some RNs that work NHs. All had trachs and 20 were on ventilators. The entire staff for the shift was 1 RN, 1 RRT and 2 CNAs for 40 total care patients. When something did happen, I couldn't just run to get copies of paperwork and stand by the door until help arrived. Nor could everybody just drop the patient they were working with and run to my assistance either. Of course, that would be the time someone would decannulate themselves just to make my night even more fun. I realized then how easy I had it in all of my 30 year career as a Paramedic even on the slave trucks of Miami in the early 80s.

I have yet to read many posts on RN and RT forums that waste as much time as those in EMS do bashing other professions. I can't even remember seeing an EMS bashing post in the RT forum but I know RTs get bashed regularly on some EMS and Flight forums. RNs and RTs also know that some in their professions actually look down on that sort of thing and will police themselves accordingly. It has something to do with professionalism. It is a good thing too since EMS has so many fragile egos.

EMS has alienated itself for so long, it doesn't know how to interact with other health care professionals. EMS has its own special career schools and rarely venture into the college world when they might co-mingle with other students of various professions. Hopefully, if EMS ever raises its educational standards some of its insecurities will disappear and they will not feel the need to constantly find fault with others to make themselves feel good.

[VentMedic]

>>> DO RN's honestly take care of 30-50 patients in a shift or on their own? That just sounds very dangerous, for both the patients as well as the RNs and CNA....and vent peoples... 8)

Our med-surg RNs in an acute hospital may have up to 15 patients. Some days they might even be lucky enough to get a CNA. One of the few things California did right was enact the nurse to patient ratio but that only only applies to hospitals. The SNF and NH RNs are still left out. However, many SNFs try to limit it to 15 or less. Unfortunately most of those patients are total care.

Read the post I did earlier about hospital safety for some amazingly mind blowing facts about our healthcare system.

Again, those of us who work in LTC facilities and hospitals are trying the best we can with the resources we have.

[Richard B the EMT]

What I now write, I do not know if it supports or undermines positions taken already by the city members.

Many times, in first the inter-facility transport (non 9-1-1 system) ambulances, and from 1985, in the municipal 9-1-1 ambulances, I have been dispatched to a SNF, usually as a call type "Other", meaning all we know is there is supposed to be a patient somewhere there. On arrival, we get directed to a floor, where we wait at an unoccupied Nurse's station for a few moments for someone to tell us which room. We do our initial patient evaluations, vital signs, place on O2 if s/s indicate need (per protocols), while awaiting a transfer report (one crew-person does most of this, while the other starts writing up the Pre-hospital Care Report <PCR>). The Nurse finally showing up at the desk says the "Charge Nurse" has the paperwork. A short wait later, the Charge Nurse shows up with the "transfer sheet", which has patient history, meds, and the reason for the transfer, which gets documented to the PCR. We then transport to the ED, where the Triage Nurse usually makes some comment on the incompetence of the SNF staff, either, "They should have been able to handle this," or "Why did they wait so long to do this transfer, the patient is one foot in the grave, the other on a banana peel." (Or, at least, words to that effect.)

What I love, figuratively speaking, is when we get a call, no information, and the patient is on a ventilator. Now we have to delay transport while awaiting the Paramedics, or if a long ETA, package and transport using the BVM (Bag Valve Mask). These are usually tubed, or trached, patients.

All I can say in conclusion, is, I don't always have these experiences, and don't always experience them on different nights at the same facilities, but the fact it happens at all is never a good thing.

[VentMedic]

On arrival, we get directed to a floor, where we wait at an unoccupied Nurse's station for a few moments for someone to tell us which room. We do our initial patient evaluations, vital signs, place on O2 if s/s indicate need (per protocols), while awaiting a transfer report (one crew-person does most of this, while the other starts writing up the Pre-hospital Care Report <PCR>). The Nurse finally showing up at the desk says the "Charge Nurse" has the paperwork. A short wait later, the Charge Nurse shows up with the "transfer sheet", which has patient history, meds, and the reason for the transfer, which gets documented to the PCR.

Do you think nurses just sit on their arses awaiting the paramedic? Rarely does anyone have time to just sit at the nurses' station. Nor, are they going to leave the patient care area if there are other patients besides the one you are there for.

And, how long does it take some EMT(P)s to complete their paperwork? Some sit around our ED for 30+ minutes working on one report. These RNs must gather up enough pertinent paperwork to avoid any mistakes from an extensive history.

As far as the ventilator patient, maybe your dispatcher and service should know what facilities are in their area. If we get a call from X facility, we know it will at least have a trach. Any EMS service should already have this information about certain facilities in their area for disaster planning. It should not be a surprise.

And yes, you can bag a vent dependent patient to the ED if no ventilator is available. Many ATVs that EMS Paramedics carry are of little use anyway on these patients if there is another respiratory issue.

[Richard B the EMT]

What I should have said in my posting was, the nurse supposedly assigned to the floor got off an elevator to meet us. I hope this was an abomination, and not common practice.

[VentMedic]

I know I am sounding pretty critical in my posts but remember your professionalism or lack of also reflects your company. Contracts for routine transport for hospitals and LTC facilities, whether ALS or BLS, are the bread and butter for some companies. In larger cities, this can be a very competitive process. Whether you realize it or not, your attitude and professional conduct are being noted. If you yell at other health care professionals regardless of the setting, it will be noted. Your supervisor may or may not be notified but regardless, the day, time and patient will be noted with your identification.

Those who say things about ED overcrowding must also remember we have to wait for transport to move patients out of the floors and ED to make room for more. If an ambulance is late, and yes you do have your very good reasons, it backs up the process.

We just have to respect the fact that no one and no system is perfect. However, the bigger professional will try to understand the situation the other is in. Inquire if the information is being gathered or if the RN can come over to give some info. The RN may be torn between getting the paperwork quickly (which is not always possible) and talking to you. He/she will be sure to catch an attitude if they make the wrong decision either way. Until then, you can do a great assessment and get your own paperwork started while waiting for the RN to cover his/her formalities for the transfer. If the patient is truly BLS, you will have a few minutes to catch your breath. If the patient is coding, you're not going anywhere anyway. If the patient is ALS, take the few minutes to get your ducks in a row. Do your assessment and then when the history arrives, you may already have figured out alot of it.

Not all nurses are bad and the nursing profession probably covers for many of the blunders of EMS more times than you realize. Nursing also has a way of floating those ED RNs that complain too much about LTC facilities to a med-surg floor or attached SNF for an attitude adjustment.

Just practice patience and good patient care. At the present, it is difficult to change how we warehouse our elderly and disabled.

[spenac]

OK everyone step back, take a breath, wait for the bell, and come out fighting. Alright that is just wrong.

Why can't we all just agree there are crappy people in every profession? Why can't we agree that at times BS is just BS? Why can't we just agree at times some declare things as BS but later others find it wasn't? OK so now everyone happy?

Darn being the kindler gentler hand holding spenac is tough.

[AMESEMT]

Wow, spenac you are doing a great job on being kinder and gentler. I agree with all that and am happy now!!!!!!

Laura Anne- All I can say is GOOOOSSSSS-FRA-BAAAAAAAA, or something like that......... *Amesemt is now calm, cool, and collected*

[Don1977]

Do you think nurses just sit on their arses awaiting the paramedic? Rarely does anyone have time to just sit at the nurses' station. Nor, are they going to leave the patient care area if there are other patients besides the one you are there for.

And, how long does it take some EMT(P)s to complete their paperwork? Some sit around our ED for 30+ minutes working on one report. These RNs must gather up enough pertinent paperwork to avoid any mistakes from an extensive history.

As far as the ventilator patient, maybe your dispatcher and service should know what facilities are in their area. If we get a call from X facility, we know it will at least have a trach. Any EMS service should already have this information about certain facilities in their area for disaster planning. It should not be a surprise.

And yes, you can bag a vent dependent patient to the ED if no ventilator is available. Many ATVs that EMS Paramedics carry are of little use anyway on these patients if there is another respiratory issue.

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.