Nursing Homes - Your general experience?

[vs-eh?]

This is a spinoff of Godfather's blog post.

I'm sorry, but the vast majority of my nursing home experience and their nurses is quite poor to lazy. When you call 911 for "your patient", I expect you to have some type of report with some type of flow to it. The vast majority of times when I unfortunately have to do a nursing home call, is me walking into a room where the patient is surprised to see me/unconscious and there is no nurse there waiting/or readily available to give me a report. I DO NOT want you to simply read off the doctors note's or the patients MARS sheet (I can do that myself). I expect you to have a little bit of insight into this pt. such as...

- Their normal mental status

- Their normal state of health

- What has changed today

- WHY 911 WAS CALLED!

- etc...

And don't shrug your shoulders and get all pissy when I GET PISSY because you obviously have zero clue about "your patient". I am not a mind reader, this patient is in your care 24 hours a day. Yes, I realize that you may have a lot of patients but I assume you generally see a "set" of patients and can at least form 3 sentences telling me what is wrong today other than reading notes and telling me "The doctor wanted them taken out".

I do not want to hear...

- This isn't my floor

- This isn't my patient

- I didn't call 911

- I just got back from vacation

- It's my first day

Do they teach people these phrases in school? Honestly I am tired of hearing them...

Keep in mind that there are exceptions, but they are few and far between. It is honestly REFRESHING to walk into a patients room and have someone give me a nice formal report *AHHHHHHHHHH*. Keep in mind that most nurses in NH are not RN's (4 year university), but are RPN's (2 years college). Not that it should matter though...

[JPINFV]

I get better reports and more concern from assisted living places (i.e. no RN, or LPN, simply just a med tech) then most SNFs. It was comical, though, the one time I've seen an RN do the entire, "I can't talk to you, I have to take care of everyone else. You have paperwork" routine to a medic.

[itku2er]

Well looks like we are gonna beat this dead horse again.. :roll: :roll: ..I will say it once again not all nursing home nurses are lazy or stupid or dont know their patients......I for one know my residents....I give a detailed report to all EMS providers that come into the facality to pick my residents up when 911 is called.....but like i have said numberous times before it works both ways we also get EMS providers that come in the facality with attitudes that suck to say the least.....so its a two way street there is good and bad in both professions and it shouldnt be, the respect and considerations should be from both sides not just one but you guys know as well as i do that sometimes when you come into the nursing home you have the attitudes of oh no not another NH patitent and treat them less than adequate unless it adds to your services pay....which is just as bad as the nurses not knowing the residents conditions and past history....like i stated before it is a TWO WAY street......to get respect you have to give respect ...

[buckeyedoc]

It's a good thing you brought this up. We filed paperwork on a nursing home with the state last night. The clinical manager of an ER happened to be in the hospital at the time and she helped us.

We had a run the other day to a facility for an 89 yof c/o N/V X's 2 days. We walked in and the LPN simply walked away. No report, no paperwork...nothing. I was pissed. As he was walking away, he said he gave her 25mg Phenergan. We found her paperwork sitting on the nurse's station, but no nurse to be found. We get her in the bus and start doing our assessment. I put the monitor on her and she was nasty blotches on her stomach and chest. Sure enough, I look at her paperwork and she's allergic to Phenergan. I gave her some Benadryl and the problem was resolved. We get her to the hospital and gave report and the doc happened to be there when we gave report. He is a good friend of my wife and me. He walked out and was on the phone to the nursing home within seconds. He didn't care who heard him, he laid into this nurse. When we went back last shift, he had been fired and an investigation begun.

Being in private EMS, we deal mostly with nursing homes. I've seen the good and the horrible. I would say there is only about 2% of nursing homes that I've seen that I would put anyone I know in for care. The staffing sucks and the staff is incompetent. I've spent the better part of today doing some research as to what qualifications nursing homes have in the state.

[Ridryder 911]

I agree 100 % ... now, a different spin off. As a nurse, I expect EMT's to be able to give the following:

Patent's name (if was given)

pertinent medication(s).. yes this means cardiac, HTN, diabetic, COPD.. and yes you should know which ones those are

a detailed history of precipitating events

meds and tx given per EMS

when and if family or other reputable person to obtain history is on the way

Challenging the treatment that was given in the ER by the physician, have a problem with his treatment, then discuss this with the Doc... naw, I didn't think so.

If I said the C-spine was cleared, and immobilization device was removed: that means the radiologist or physician determined it was safe... pretty impressive to argue from someone whom can't read an x-ray or probably even name the parts of a vertebrae

No.. when I say a med has to be on a pump.. I do not mean gravity drips or dial a rate IV tubing...NO, I do NOT trust them, yes, a few extra drops in some meds will KILL someone!

Really, temperature is a vital sign

No.. not all patients need large bore IV's

Really, no one is impressed that you can intubate or start IV's.. that is your job...

Please, your job is important .. but.. it is part of the health care team.. not, the whole team

Professionalism, is not wearing a baseball cap, T-shirt, with EMT in large block letters and your shirt tails hanging out and your butt crack showing...with 30 pounds of gear hanging off your belt....

Yes, people do listen to what you say... therefore, if you do not know how to pronounce a medical term or procedure, it is best to use common language, then to be thought of as a fool.. and people determine your competency on how well you can discuss and the behavior in-between calls.. so cursing, flirting, horse playing does not represent you very well.

R/r911

[Katee]

I used to work at a nursing home. Before I worked there (when I just had passed EMT class), we were called all the time. They would dispatch two volunteer fire departments and one ALS transport service everytime they'd call 911. Fifty percent of the time, they couldn't get anyone out to take someone into the hospital for something routine. So, they would call for an ambulance to transport. My fire dept doesn't transport and the other dept doesn't transport either. Therefore, they'd dispatch us both out with the rig from town to transport. *stupid, really*.

Most times, the "med person" would have all of the paperwork ready to go and vitals taken prior to our arrival. Other times we would walk in and say "which room am I going to?". Then you'd have to wait for someone to direct you to the room and you ask what the problem is... the person who told you what room would have no idea. Grrrr.

I guess it depends on the day of the week. :roll:

[bassnmedic]

Rid, you are exactly right to expect the above items from field paramedics and I for one believe that professionalism is paramount in how we interact with patients, nurses, doctors and other medics as well as the general public.

With that being said, it is the "Paragods" out there that think they are the end to all ends and God's gift to EMS that are giving "real" paramedics a bad rap. Arguing with nurses, questioning Docs and nurses as to their care only shows ignorance and arrogance, not intelligence and professionalism.

Thank you for shopping at wal-mart and come again.

Todd

[vs-eh?]

I used to work at a nursing home. Before I worked there (when I just had passed EMT class), we were called all the time. They would dispatch two volunteer fire departments and one ALS transport service everytime they'd call 911. Fifty percent of the time, they couldn't get anyone out to take someone into the hospital for something routine. So, they would call for an ambulance to transport. My fire dept doesn't transport and the other dept doesn't transport either. Therefore, they'd dispatch us both out with the rig from town to transport. *stupid, really*.

Whoa whoa whoa...

I may bash NH staff but...

- At minimum they usually have at least a 2-year college degree (or equivalent) here.

- They dispatch 2 FD's (what does that mean like a fire truck and ambulance and stuff) and an ALS car for something "routine"? Sorry if anything that is BAD DISPATCHING and services looking to validate their expenses. So what like 10 people show up for some 80 year old's cellulitis in a NH? LOL...It reinforces my gongshow mentality of aspects of US EMS. No doubt crews go L+S to shite like this...

[buckeyedoc]

Rid,

I totally agree. Working in the ER as a medic, I see a broad spectrum of EMS agencies. Some are great and present the case in great detail and others don't have a clue. Oh, by the way, one doesn't mean your volunteer and the other paid. I've seen good and bad from both. There has been many times that a squad shows up and I'm the only one to check them in. I expect the same report that you would give a nurse or doctor.

On another note, yesterday, we had a little old lady w/ RLQ abd. pain. v/s as follows "B/P-120/60, P-80, RR-14, Temp.-98.6, SpO2-97% RA". I am lucky that I have a basic as a partner who I trust. When he gets a v/s, I trust it. He did his thing and got "B/P-82/40 P-122, R-24, Temp-101.7, Sp02-90%. They had textbook v/s and they weren't even close. I think that nursing homes (and hospitals for that matter) rely WAY too much on technology. Those little writst automatic b/p cuffs aren't very accurate. It's a shame that people don't know how to take a manual B/P anymore.

[1aCe3]

I'd have to agree that I wouldnt put any family member in most of the nursing home's I've seen. The environment just plain reeks of disaster. Some of them are just plain unsanitary. As for the nursing home staff, yes, they vary. That's usually how accidents happen. From falls to patients ODing on drugs they got off the street right outside the facility, it does get ridiculous at times. If it's one thing I've had in my experience working at a transfer company, it's usually when the staff screws up majorly that we actually have a call where we can do much more than the usual. They're either really good or really bad. Yes, some places do have the nurses that just leave the paperwork on the desk while the patient is basically going down under, but some don't. There's one that I know of that even has the doctor waiting in the lobby for us to give the full report himself.