Insert Snark Here

English: Linear Skull Fracture with arrow poin...

What this patient did not have

Mr. CD, 88, took a little tumble at the nursing home when he slipped on a loose rug (or something, the details are a little vague here), obtained for his trouble a scalp laceration the length of Q-tip on his temple, bled like a stuck pig, transported by EMS, triaged, assessed by both MD and RN, x-rayed, CT’d, declared medically cleared and fit to go home, deblooded, stapled, tetanus’d, acquired a head dressing worthy of a maharajah, and finally sent back to the nursing via a private ambulance and their ill-paid yet (hopefully) competent attendants.

Whereupon the RPN (i.e. LPN for you out of province types) or whoever was minding the door of the nursing home refused to take the patient back.

“Oh my God, he needs to go back the emerg,” she said, eyeing, perhaps, the overwrought head bandage. “He has a skull fracture! I can tell!” And promptly sent him back, alert, oriented x 3 — and bemused.

I have only two possible explanations for her extraordinary statement: she either is wasting her time at the nursing home and depriving humanity of a set of assessment skill so exquisite she can, using her psychic x-ray powers, detect a skull fracture under approximately twenty layers of clean, white 4 x 4 sponges and tape gauze, or else she thinks despite all the assessments and investigations, we are complete boobs. ( Admittedly, I have a sneaking sympathy at times for the second possibility.)

There is actually a third possibility, but I am far too polite to mention it.

That’s all I got. Feel free to insert your own snark.

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  1. #1 by Jenn Jilks on Sunday 26 February 2012 - 1235

    It’s peculiar, that most long-term care homes have enough trouble trying to get a doctor to see their residents, maybe we don’t need them in LTC! With wunderNurse and her skills.
    There are many possibilities, she was afraid of a lawsuit if he DID have more issues, or was exerting her power, or she’s a bad nurse!

    In my experiences many RPNs are seldom convinced patients need to see a doctor! Drs visit once a week, whether the residents seem to need them or not.
    I accompanied my paraplegic friends, retired nurse of 41 years, to Emerg. as she was convinced she had pneumonia. The nurses refused to believe her. They patronised her, and were most unsympathetic! Turned out not to be, but with the whooping cough going around, you’d think…

  2. #2 by Anonymous on Sunday 26 February 2012 - 2247

    Do you think she fractured his skull?
    Or she didn’t want one more on her census that night?

  3. #3 by Lynda M O on Monday 27 February 2012 - 0203

    I wondered the same @Anonymous.

    • #4 by torontoemerg on Monday 27 February 2012 - 0834

      I would not in a second believe the first choice. No. 2 might be more plausible,

  4. #5 by PsychoJenic on Thursday 01 March 2012 - 1725

    OH MY GOD I am so happy I found you. I also work in the GTA in the ER (in a MH capacity) and I am tired of fighting with nursing homes to take their residents back.

    Work. I think they are afraid of it.

    • #6 by torontoemerg on Thursday 01 March 2012 - 1804

      Well, not all nursing homes are created equal. I have had some very good dealings with some nursing home RPNs. But then comes the 85-year-old nursing home resident who has “suddenly” developed a sepsis-grade pneumonia. . .

  5. #7 by Mandyem on Thursday 01 March 2012 - 1738

    “In my experiences many RPNs are seldom convinced patients need to see a doctor!”

    I am sorry but as an ER RPN in the GTA please don’t lump us all in the same box! I may be one of the Rare breed but worked my proverbial butt off. I am with PsychoJenic when I say it is near impossible to get some nursing homes to take their residents back….The boomerang effect is sickening!

    • #8 by torontoemerg on Thursday 01 March 2012 - 1802

      Thanks for the comment, and I wouldn’t dream of doing so. Boomerang effect is right — we’re starting to refer to them as boomerangs.

  6. #9 by Ali on Thursday 01 March 2012 - 2126

    I have lost count of how many fights I’ve gotten into with nursing homes to take their own residents back. The most memorable was because the order was written at 1700 on a Friday. I called the nursing home to let them know and that I would be arranging transport for the next day, and I couldn’t even get that out before I was told “well, it’s too late today, and we don’t have pharmacy services tomorrow or Sunday, so she’ll have to wait until Monday” It turned into a full day affair, and I had to get the hospital supervisor involved in the discharge.

  7. #10 by Nursing Homes on Saturday 30 June 2012 - 0613

    Thanks to aware about this crisis, Nice article.Thanks to share that information with us.Keep it up , every one want to aware about these problem.

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