Wednesday, March 21, 2007

Nursing Homes.....

My last post spoke of an experience of mine at a nursing home that pissed me off to say the least. What pissed me off the most was the fact that she had sat there all day with an obviously broken arm. The staff, for whatever reason, decided that she needed an x-ray. WHY? It doesn't take an intelligent person to see what I saw and say, "yep, that's broke." Then no one was going to own up to it. I can't say that someone intentionally broke her arm, but along with the inability to speak, she was also bed-bound! She couldn't even roll over without help! So someone had to be with her when it happened. OK, calming down now....

This isn't the only thing that has ever pissed me off at a nursing home. Respiratory distress and the patient is on 2 liters with a mask, calls for confusion and the patient has diagnosed dementia and various other incidents. But I've given this nursing home thing a lot of thought. Why do the staff at these places do what they do? Are they really that stupid? Or are they just un-educated? I guess it maybe the optimist in me, or maybe the lack of experience, but I just can't believe they are all total idiots. I mean every now and again you get a good nurse or tech and they are actually on a first name basis with the patient and know their history and why they are going to the hospital when we arrive. It doesn't happen often, but every once in a while you get lucky. Another thing is that, at least around here, the nurses can't do much of anything without a physician's approval. If anything happens to the patient, no matter what the nurse may think, they have to call the doctor. Now lets take a new nurse straight out of college and goes to work in a nursing home. At this point some people may say this is a obvious show of lack of intelligence. But as my pappy used to say "different strokes for different folks" and some people hear their calling in different places. Back to our nurse, he/she wants to do good, wants to take care of the elderly, the infirm and the demented. But every time he/she sees something that needs to be done, he/she has to call the doc. Every time one of his/her beloved patients falls, he/she has to send them out. Every time one of them hiccups yep, you guessed it, call the ambulance. Now, honestly, wouldn't that discourage you? it would me. So now take that same nurse and put 5 years experience on him/her. For 5 years he/she can't do anything on his/her own. He/she gets reliant on that doc to make all the decisions, because he/she doesn't have a choice. Ambulance Driver along with many other EMS bloggers have made many statements on how to improve the standard of care in nursing homes including better pay, benefits and facilities. I agree with all of those. My idea is why not give them some protocols? Things they can do own their own before calling the doc and subsequently calling EMS. Simple things like starting an IV and giving fluid for dehydration, antiemetics for nausea/vomiting and education on oxygen delivery devices. I don't know about other nursing homes, but the ones around here can't do even these simple things without calling for physician approval first. Now I know that I am not even a medic yet, and I am still "wet behind the ears", but I see this as something that can be done. I think that if you give the staff a little autonomy, (with the proper education), they might take a little more interest and improve the care in these types of facilities. I'll get off my soapbox now. But I would like to hear what my 2-3 readers think about this. Especially the ones with more experience than I.

1 comment:

podmedic said...

I have to agree with you about the nurses' limitations. As EMS providers, we are taught to think on our feet within a broad basis of our protocols or standing orders. Because of the wide range of patients we might see in a variety of conditions -- we have a correspondingly wide range of treatment options to choose from.

Nurses don't. They usually have very limited standing orders -- especially in a nursing home. Their orders are written to cover the average patient and for the rest -- they have US!

While some long term care facilities have a well deserved bad reputation, I believe most are staffed by caring people who are doing the best they can within the confines of the rules and resources they have.

This might be an opportunity for some cross talk and facility education. Learn what their resources are and why they do things the way they do. I guarantee that they probably have EMS gripe sessions the way we have Nursing Home gripe sessions.

Great blog -- keep it up!