If I ever write a book on nursing stupid, I will start with nursing home nurses. I know it’s bad joss to speak ill of your nursing colleagues. I understand there are some highly skilled and dedicated RNs out there staffing nursing homes, even if I don’t quite believe it. But sometimes the sheer dumbassedness of some of them astonishes me, who has seen stupid on a cosmic scale.
Patient EF was sent in the other day by Golden Pastures Retirement Home. Golden Pastures is, by the way, one of those combined retirement home/nursing home deals, with nursing staff on both sides to “take care of your health care needs”, as the sales pamphlets so quaintly put it. EF was an elderly 89 year-old guy with vascular dementia and whose faculties, EMS told me, had rapidly declined to the point the retirement home couldn’t cope. A common enough story. He was conscious and alert, not particularly confused, and fully dressed on the ambulance gurney; clearly he did not understand why he’d been brought to hospital. Across the retirement home history sheet the RN had scrawled, “EF is NOT to return to Golden Pastures — Too Unsuitable.”
It turned out — after much investigation by Social Work, speaking with family and Home Care and also making a gazillion phone calls — that EF’s dementia had been of ongoing concern for months, and that the family had taken an active, proper role and had done the right thing by preparing an elaborate, well-thought out care plan. This involved, as a start, wheeling EF in a chair down the connecting corridor from Golden Pastures Retirement Home to Golden Pastures Nursing Home.
But the RN at Golden Pastures decided that she was far, far too busy to actually make the transfer, which, as I say, was a two minute walk down a hallway. And also far too busy to telephone one of EF’s innumerable, eagerly helpful children to ask them to make the transfer. It was much better, she reasoned, to telephone 911 for EMS (the “E” of which, I remind you, stands for Emergency) to take the patient to our emerg because she was either too lazy or too stupid to carry out a carefully delineated care plan. Or maybe a little of both.
Fortunately, when I was triaging EF our delightful, hardworking social worker, who happened to hear my triage assessment, got on the case immediately.
And it was lucky too, that Social Work figured all of this out before EF fell into the well-meaning hands of the internists, who would have admitted him, upsetting all the detailed, delicate arrangements for his placement. He would have ended up rotting in ALC* for months.
So this little fuster-cluck gap in communication cost the health care system: an EMS pickup, registration, nursing care for twelve hours in the Emergency (which is not cheap), physician assessment, and an ambulance ride back to Golden Pastures. Probably a few thousand dollars worth of unnecessary care. Then there are, as a kind of sorry bonus, the intangibles of tying up an emerg bed for twelve hours, causing the patient and family an enormous amount of anxiety over potentially wasted effort in arranging care in the first place, taking up Social Work’s time and so on. Not to mention the stress and upset done to the patient himself, who was yanked out of familiar surroundings for a completely useless hospital stay. I might add that we tell the elderly and their families to sort out their arrangements ahead of time, so this kind of thing doesn’t happen. Apparently none of this entered into cogitations of Retirement Home Nurse. All in all, not bad for a day’s work.
Too bad we couldn’t bill the retirement home for costs.