When will we ever get good press?
Jacqueline Vance, RNC, CDONA/LTC
You know, a lot of great stuff happens in the long-term and post-acute care setting. But nooooooo, no one ever wants to talk about the good stuff. One bad apple and the mainstream press go wild and we all get the black eye.
And unfortunately, this does cause our patients and residents harm. In doing a deep dive analysis of causation for return to hospitalization, a big push is from families. They have literally been brainwashed that the only place their loved ones can receive great clinical care is in the hospital.
Of course, we all know this is not true or we would not have the term “transfer trauma.” Adverse events and complications upon transitions to the acute-care centers are common. Also, transitions from a SNF to the hospital expose patients/residents to many risks; including delirium, under nutrition, serious infections, skin breakdown and adverse drug reactions.
When is the last time you transferred a resident to the hospital who had a three-day day stay or more, who did not return with at least a stage 2 pressure injury to the sacrum or heels? Our patients/residents suffer from things like being on a hard hospital gurney for hours on end WITHOUT repositioning, invasive procedures, multiple tests, and a siloed health system where multiple doctors, residents and specialists are all seeing the patient but not speaking to each other.
But there is something we can do. We have to stop being passive and get ready for battle. That's right, guys. Listen to Nurse Jackie and gird your loins!
Dr. Medical Director, let your attending staff know that they may have to get on the phone with the family and talk to them and explain why the SNF may be the best place of care instead of saying, “Well, if the family wants them to go, send them.”
I mean, come on, if a family said, “I want Dad to get his appendix out before it goes bad,” would you say OK? Of course not, because it's just not necessary and would expose the patient to dangers.
Nurses, you need to know all of your facility's clinical capabilities and calmly and respectfully talk to the family and/or resident who is requesting to go to the hospital when you KNOW you can care for them in your facility. Ask questions like, “What do you think the hospital has that we don't have? Access to X-rays? We can get a stat X-ray.” “Labs? We can get stat labs.” “Oxygen? Yup, we have that and can monitor oxygen saturations.” “Well, doctors? Your doctor can come in and see you here.”
Yes, sometime a patient/resident does have to go to the hospital. We don't have ICUs and we can't stop things like internal bleeding and we don't do surgery. But we sure as heck can treat pneumonia and infections.
So fight the good fight, let them know you rock clinically and that guess what? We care about and know your loved one too! Maybe we can change the world view by word of mouth! (But, heck, I am a cockeyed optimist!)
Keeping it Real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, an APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.