When will the hurting stop

[cledus]

I have returned, and am ready to get things rolling again. Yes some of you disslike my colorful thoughts, but is it not better to be honest, than loved . There is still a question that needs answering, at what south american nursing school due they scrape the nursing staff for the nursing homes from? I have had the "luck" to be there for some of the worst I can't think of words to describe it. Like the unresponsive Pt with snorring breaths, that magicly becomes alert when stimulated, and when you dare to state that the Pt was sleeping they look at you like you have horns(well I do, but that isn't the point) how dare you question there medical savy, they are a LPN for goodness sake. The SOB(short of breath) for three days and as they take ther last breath they call 911, and then get frustrated when you suggest a non rebreather, at more than 3 Lpm . Am I wrong in thinking that there is a whole groop of staff that are working for the angel of death, or that if we removed them from the scene the average age of our older people would be in the 200's. please share your thoughts.

[Medic13]

I have a good friend who used to work at one of those facilities in the county. She told me the biggest problem is simply that there isn't enough staff. Then add on the fact that the residents are frequently complaining or screaming about something, even when nothing is wrong. Then the family of the resident can't make up their minds...
I know it's no excuse for some of the sheer stupidity we see, but after she explained it, I sorta understand how they can get burned out real quick.
Just one more reason why I'd never work in one of those places.

[blueeighty8]

Share my thoughts? Like wanting to hit someone for their unbelievable stupidity? How can someone that spent years in school to be a nurse, know less than an EMT with 120 hours of training. By all accounts, they treat more patients every day, and when you have hard floors and frail bodies; you have a mixture for a controlled mass casualty, so to speak. Yet so often, I see all that training and knowledge get flushed right down the toilet!

Often I find myself holding back from a nursing home staff, the inevitable comment, and the only one than any sensible, medical trained person can dig up ..

WHAT THE HELL IS WRONG WITH YOU!?!?!

Why did you wait, what did you do, have you done anything, WHY NOT?

Severe SOB... began with the morning shift

Chest pain.. for six hours

patient has been blowing bubbles since shift change (11pm). Call comes in at 7am.

nurses can't do the most simple emergency intervention, can't increase oxygen, can't suction, can't do CPR..

But they can pick up someone who has fallen and fractured several bones, and put them back in bed. And call an ambulance eight hours later.

That compound fracture probably looked the same way when you bandaged it eight hours ago, did you think it would heal?

letting people with a DNR die of something that could have been changed with an increase in oxygen flow, but not doing it because they have a DNR, and you didn't want to disturb the doctor.

Roll into a facility, nurses station empty, patients room-has the patient, no nurses, the patients condition can be anything from perfectly fine, to dead for hours. We report it to the hospitals as is suggested, but nothing gets done. I agree many are understaffed, but that is no excuse, hire more people, lives are being lost because of this fact.

How about the common calls for full arrest, do you notice most all have something in common?

SHIFT CHANGE

God forbid someone care about a whole building full of unsupervised elderly folks with serious illnesses.

[cledus]

I like when the staff ( I can't bring my self to call them Nurses) Is so not around and you walk in the room with two people that look like they knew Christ personaly and are about to become reaquanted. I walk into the hall and do my best to make so much noise it would wake the dead. It takes a littel time (5 min.) and they come to see what has happened. They are upset that I don't know which Pt that looks like death warmed over is the one with the problem. Sorry I see two people in danger. I have had them refuse to give me a report, and then look astonished when I belittle them infront of the CNA who looks at them like god.

[GVEMS30]

blueeighty8 said:

nurses can't do the most simple emergency intervention, can't increase oxygen, can't suction, can't do CPR..

Not to excuse less then professional conduct of nursing staff I haven’t observed, but, they may not be allowed to do anything. For example as prehospital providers we can hand out oxygen like candy. A nurse can only administer it with a physician’s order. Then there is the DNR, DNI, DNH, Advanced Directives and such all needed to be considered. Yea, I have my share of “what vending machine did you get your nursing diploma from stories”, but there can be another side to this.

[blueeighty8]

lfrey said:

blueeighty8 said:

nurses can't do the most simple emergency intervention, can't increase oxygen, can't suction, can't do CPR..

Not to excuse less then professional conduct of nursing staff I haven’t observed, but, they may not be allowed to do anything. For example as prehospital providers we can hand out oxygen like candy. A nurse can only administer it with a physician’s order. Then there is the DNR, DNI, DNH, Advanced Directives and such all needed to be considered. Yea, I have my share of “what vending machine did you get your nursing diploma from stories”, but there can be another side to this.

Call the physcian and get him out of bed. My god, why would they do that though. Save someones life through early intervention? That's a horrible idea!

[911wacker]

Couple of pointers for you............

# 1 - When you go to one of these facilities, don't expect anything from the staff. This will save you the disapointment 99% of the time when they did something stupid which you should be used to by now.

# 2 - When you find that 1% patient that was treated properly prior to your arrival, make sure you make a big deal of it...........like that nurse just won a million bucks in the lottery. So maybe next time they will remember how nice and greatfull you were that they actually did something and they may do it agian.

# 3 - When you find that NRB mask at 2 lpm, keep your cool and be polite while making a suggestion that the patient may benefit slightly more using a NC while delivering 6 lpm or less of oxygen. You may also ask the nurse if they would like an inservice sponsored by your EMS company on the proper usage of oxygen and delivery devices.

# 4 - If that doesn't work, complain to your supervisors or manager. I know for a fact that at one service I work for we have gone to management and seen LARGE improvements in a particular Nursing Home we respond to.

[blueeighty8]

911wacker said:

# 3 - When you find that NRB mask at 2 lpm, keep your cool and be polite while making a suggestion that the patient may benefit slightly more using a NC while delivering 6 lpm or less of oxygen. You may also ask the nurse if they would like an inservice sponsored by your EMS company on the proper usage of oxygen and delivery devices.

* Note to self. Refrain from removing the old sticky mask and throwing it at the face of the male CNA (aka Can Not Assist) who is worried more about the color of the overhead curtain than the patient who he put the mask on with out turn the oxygen generator on.

[cledus]

Larry F., you be careful we all know that you are jumping the wall and going to nursing school. 911 I am afraid that it is hopless, the Nursing staf are trying as hard as they can to kill as often as possable. I am going to start a crusade to stop them. Every one of them who speaks to me will be smacked on the nose with a rolled newspaper

[GVEMS30]

Like I said Cledus, I have my share of stories too; I was just trying to provide an alterative point of view. I can think I can use a NRB correctly and I don’t think aspiration patients need Furosemide and I didn’t learn any of that in nursing school. I also remember the emergency department nurses who taught me (and you I bet) a few things. Best of luck with your crusade. ;D

[charlotte_ff]

know what bugs me, and this is true with nurses and ems probividers alike. they treat a DNR as a do not treat. a DNR stands for do not rescusitate-meaning they are dead. while they are still alive you can treat them and possibly prevent them from dying. i guess that is too much paperwork if you actually treat them instead of just loading them in the ambulance and transporting.

[Medic13]

charlotteff said:

they treat a DNR as a do not treat

Often that's exactly what it means during a code, depending on what the patient/family requests in the DNR. As long as it's in our hands, we're legally obligated to follow the request. Some don't want a tube, some don't want to be sparked, some don't want CPR, some don't want an IV, ect... and some do request those procedures. To violate that request because you feel you can revive the patient with that procedure is gonna open you and your employer up to hell. The patient doesn't have to be dead for that DNR to take effect.
And why the nursing homes call us for the patients with a DNR limiting us to nothing? ...who knows.

IMO, it's a little sketchier when responding to a residence, cause it's not uncommon for the family to wait till one or more of those procedures has been done before telling you about that DNR.

[9Wacker1]

Just because there is a DNR, though, doesn't mean the staff can't get them treated for a runny nose. DNR's apply to a patient who has crashed (or is crashing). Of course we need to follow the DNR (when it actually gets to us) but no patient should be withheld preventive care just because they're old or have a DNR. It IS frustrating to see someone heading to the hospital in our rig after being sick for days when a phone call or Dr. visit earlier in the week might have kept them from getting that bad. Just my thoughts.

[Medic13]

9tech9 said:

Just because there is a DNR, though, doesn't mean the staff can't get them treated for a runny nose. DNR's apply to a patient who has crashed (or is crashing). Of course we need to follow the DNR (when it actually gets to us) but no patient should be withheld preventive care just because they're old or have a DNR. It IS frustrating to see someone heading to the hospital in our rig after being sick for days when a phone call or Dr. visit earlier in the week might have kept them from getting that bad. Just my thoughts.

Well yeah... I think that goes along with the "common sense" aspect of both fields (which some people don't get). No patient should be denied care to prevent future catastrophe, but once it happens, their wishes should be respected.

[9Wacker1]

Agreed.