Wednesday, March 10, 2010

An open letter to nursing home "nurses"

Dear nurses?/clowns?/hobos someone is paying to take care of sick elderly people?:

Please stop. Seriously. Stop sending stupid stupid shit to the ER ALL THE TIME. Even as I say this, I know it is absolutely too much to ask for you to stop sending over patients for lab values that were drawn two weeks ago that are abnormal, but have been treated already, instead of just calling the doctor. I know it's really a lot to ask for you to take a second blood pressure before sending a patient over for hypotension, so that we don't get them here and waste our time working up a patient with a pressure of 120/80. I know that's really a little too much to expect.
I won't even ask this of you. But please advise, just for next time-
If EMTs show up to your "CPR in progress" and the patient is looking at you and looking around the room while you do compressions, they probably always had a pulse. You just didn't feel the pulse because you are terrible at being a nurse and you should stop forever.
A "little grandma seizure" is not a thing. A Grand Mal seizure is a thing, but they don't come in little size. Only grand. Like grande. Or large.
If you walk into a room to find your patient cold, pulseless, and in rigor mortis, they have been dead for some time. Please don't call an ambulance. Call the funeral home. Quit doing compressions. You're just beating up a corpse.
Nausea is not a reason to stop all medicines. Especially when said medicines are for seizures or diabetes.
Also, guys. I'm really sorry to keep I keep interupting you at night. I know you're very busy sleeping or watching Cheaters, and that you just got here and you don't know anything about this patient, but sometimes I just have to call and check just to make sure you're serious. I know I shouldn't really be surprised by anything at this point, but you guys always manage to out do yourselves.
Congrats on that,
xoxo, Hood Nurse


  1. I know exactly what you mean. I work in a skilled nursing facility, we kind of operate as a mini med surg unit. We're taking on 20-30 patients a piece (with the help of CNAs) but it can get pretty crazy. However, it drives me crazy when many of my co-workers send patients to the ER for the stupidest things. I rarely send anyone out for exactly the points you made here. One cocky nurse (thinks he's a doctor) I work with brags about how many patients he's sent out recently. Dumb ass. He sends people out when he doesn't want to deal with things. Just because someone calmly points to their chest and states they have pain, does not mean that it is CHEST PAIN. Try some interventions first, if they don't work and the pain in severe THEN send them out. Also this same tool "diagnosed" a patient as having a stroke the other day, called the MD and family who didn't want him to go to the ER. So the next shift comes on, takes one look at the guy, checks his blood sugar to find out that he was 32. Gave him some glucose and guess what, he was fine. Previously mentioned idiot nurse comes in that night for his shift and asked me "how's the guy that had a stroke this morning doing?" I told him there was NO STROKE. Idiot needs to learn that we are not allowed to diagnose, let alone tell the family said diagnoses when you really have no idea.

    That being said I can't wait to get a different job. This was just a starter job because nothing else was working out (eff this economy) While I am challenged every day it is the stigma of working in these facilities. People don't think you're a real nurse. And that's probably because I work with a few of these asshats that fill up the country's ERs with non-emergent things.

  2. Holy crap! 20 to 30? Those are some crazy ass patient ratios, especially with the number of meds the patients we get seem to be on and the number of times they need to be cleaned up. I imagine it's probably the kind of job that is actually really hard if you're a good nurse but can be made easy if you don't care about your patients, since a lot of the ones we see have needs but can't ask for anything.
    It's actually really comforting to hear from you. It's good to know there are nurses out there in these facilities that have integrity and care about their jobs- your patients are lucky to have you. Unfortunately, I think the view we get of skilled care nurses are kind of tainted here in the ER because we mostly see the stupid ones who call the ambulance for everything.

  3. Exactly. It's 20-30 but WITH help I should add. There's still a lot of nursing care. But we have med aides and CNAs. That's not to say that we don't still pass meds or anything else, but you've got help. Still pretty crazy. Our acuity is insane now and only getting worse. I miss the days of easy hip fractures!

  4. On another note: If you ever get any patients sent in to ER by the "phone triage nurse"from the general public...and it seems like there are too many being sent is because u are only seeing the ones we send in...not the ones told to stay home....there are countless idiots we tell to stay home and do home treatment or make an appointment next wk in their MD office that were actually REALLY going to rush into ER.....we get angry phonecalls from ER docs and RNs all the time about some pt that was "sent in" when we look back in our notes...sometimes the patient was told to stay home, but went in anyway and blamed us... ;) not sure if u have a lot of phone triage RNs where u are...but here where I am it is a province wide service to try and curb the ER visits.... :) and help patients make more informed decisions rather than "a friend told me that this symptom could mean i am dying...."