Ooooooooh, I am SO ticked off right now!!!

[LoriAlabamaRN]

:angryfire OK, here is what happened this morning.

One of my residents just came back from the hospital Thursday after a weeklong stay for pneumonia/exacerbation of COPD. Her nurse called me a little after midnight because her O2 sats had dropped to 83% on 3L O2PNC. She was also very hard to arouse. I called the ambulance for transfer, called report to the ER. Her MD was there and advised me to go ahead and bump her O2 to 5L (even though she is COPD) and put her on a mask. OK, done. By the time the ambulance arrives, her O2 sat was 90-91% and holding, but she was still close to unresponsive. When the EMT walks in, he stops, gives a "oh you idiot" sigh and said "Well, there's your problem right there. I'm not trying to hurt your feelings, but you are killing this lady. Do you even have a clue about nursing?" I stood there with my mouth open and then said "What are you talking about?" He proceeds to tell me that since I put her on a mask instead of leaving her on a nasal cannula, that I am suffocating her. I told him firmly that I had spoken with her doctor, done exactly what HE told me, and that her sats had come up to 91% as a result. He laughs at me- LAUGHS at me, and says "Oh, right. I'm so sure."

:angryfire

To make things worse, he reaches down and unplugs her O2 and takes off her mask, telling his partner to get the tank ready. That's right, he didn't leave her on O2 until the tank was ready for him to switch to, he just took it off. Well, his partner can't find the right mask, then the right tubing, and I am watching this poor woman gasp like a fish as her sats plummet. I try to get around the stretcher to put her mask back on myself, and he blocks me and says "Look, I am TAKING CARE OF IT." That poor woman was off oxygen for SIX MINUTES and her O2 sat was 72% when they finally got it hooked back up. Oh, and what did he use? A MASK. :trout:

Needless to say, as soon as they left I called the ambulance dispatcher, got his name and told them how incredibly rude and unprofessional this man was and that I will be filing a complaint. :angryfire

[nursemike, ASN, RN]

Why is it those who know the least are so often the quickest to second-guess?

I've had to get rather firm, lately, with a couple of aides who appear to think treating them decently is an invitation to question my judgement or write their own orders--well, they aren't quite enough to write them. Even had a phlebotomist try to tell me a nonverbal, GCS 7-8 depressed skull fracture was refusing to be stuck. Hallelujah--it's a miracle!

We do have one new aide who's trained as a Paramedic, who is kind of amusing and not at all inappropriate. He'll go out of his way to report things like a patient who was deeply asleep with a BP a little below normal at midnight is now awake with a BP on the high end of normal at o400. Say a jump from 105/60 to 135/70. Yes, he's right, that's a 30 point jump in systolic in four hours. So I thank him and say I'll keep an eye on it. It may just be me, but sometimes I think he looks a bit disappointed. Still, he never gets out of line, and I do want him to keep reporting anything he thinks is worth reporting. I'm just not quite ready to page for a hydralazine order for 135/70...

[betweenprofessions]

Okay...some perspective of this incident. There are a lot of EMT's and Paramedics that are ignorant about the system in a LTC facility. You all are limited in most instances, as to what you can treat in an emergency. But you have vast and valuable knowledge in other areas.

Having been a paramedic for a few years now, it has been my experience that most "arrogant" EMT's and Paramedic's are usually very new and inexperienced.

I don't know the individual that was disrespectful to you, nor do I know his years of service. But if I had to guess about what his issue was, I would surmise, exhaustion. We work some very VERY long hours. It is very difficult to switch gears from a drive-by shooting, or a horrific DOA, to a person with a slightly elevated temperature and diarrhea that needs to be transferred for ER evaluation (not that this isn't important). Your patient was obviously more acute, and the paramedic's behavior was unacceptable. But what I am hoping for is more understanding between healthcare professionals.

When we have been working for 20 hours straight, without a break, sometimes we aren't always chipper when we walk through the door. There are shortages of paramedics in many areas of the country right now, and we are just plain overworked (just like nurses).

I think that if I were to write a complaint about every physician and nurse that had been disrespectful to me since I first entered the profession, the paper stacks would be higher than the roof of my house.

I hope that you are never in this situation again, and if you are....put them in their place. Many times they will realize that they are being jerks and will be apologetic.

But anywho, I respect your position in LTC, as I know that you have a lot of patients to attend to, and depending on where you work, sometimes the funds are low. Thank God there are people like yourself that have the compassion and patience to deal with challenging patients on a regular basis.

We are all professionals and under stress. Hopefully someday we will all be on the same page. I'm optimistic.

EMT-P 10 years and current RN student.

[nursemike, ASN, RN]

Although I'm all for a degree of forebearance toward colleagues who may be having a bad day, the healthcare industry will never be healthy until more of us understand that rudeness toward others does nothing to reduce stress. Even if the paramedic in question had been right about what is best for the patient, explaining his rationale would have been far more professional. There can be no collaboration without respect.

[UM Review RN, ASN, RN]

Okay...some perspective of this incident. There are a lot of EMT's and Paramedics that are ignorant about the system in a LTC facility. You all are limited in most instances, as to what you can treat in an emergency. But you have vast and valuable knowledge in other areas.

Having been a paramedic for a few years now, it has been my experience that most "arrogant" EMT's and Paramedic's are usually very new and inexperienced.

I don't know the individual that was disrespectful to you, nor do I know his years of service. But if I had to guess about what his issue was, I would surmise, exhaustion. We work some very VERY long hours. It is very difficult to switch gears from a drive-by shooting, or a horrific DOA, to a person with a slightly elevated temperature and diarrhea that needs to be transferred for ER evaluation (not that this isn't important). Your patient was obviously more acute, and the paramedic's behavior was unacceptable. But what I am hoping for is more understanding between healthcare professionals.

When we have been working for 20 hours straight, without a break, sometimes we aren't always chipper when we walk through the door. There are shortages of paramedics in many areas of the country right now, and we are just plain overworked (just like nurses).

I think that if I were to write a complaint about every physician and nurse that had been disrespectful to me since I first entered the profession, the paper stacks would be higher than the roof of my house.

I hope that you are never in this situation again, and if you are....put them in their place. Many times they will realize that they are being jerks and will be apologetic.

But anywho, I respect your position in LTC, as I know that you have a lot of patients to attend to, and depending on where you work, sometimes the funds are low. Thank God there are people like yourself that have the compassion and patience to deal with challenging patients on a regular basis.

We are all professionals and under stress. Hopefully someday we will all be on the same page. I'm optimistic.

EMT-P 10 years and current RN student.

I believe that I can speak for a lot of nurses when I say that the rudeness was not the major issue in this case. We're nurses; we can prioritize. The patient comes first. We can get over someone acting like a horse's butt, in fact, we do it all the time. We have to deal with docs, remember? So we know a little bit about stress.

The biggest problems were the refusal of the EMT to take Report as well as EMT's insistence in treating a decompensating patient in the wrong way, which seriously could've compromised or jeopardized that patient's situation.

Both of those infractions involved the care of the patient, both could've had serious consequences for that patient--or for future COPDers, had this issue not been addressed.

Lori, you rock! I'm so glad you reported the problem.

[LoriAlabamaRN]

Angie, you hit the nail on the head. I've had other EMTs who made rude comments before, especially if they have to come to our facility more than once on any given shift. (Hey, it has happened before- we've had a code and a fall with fracture the same night before). I've never reported any of them- just grumbled to myself a bit. The difference was, in this instance he harmed my patient. Her sats went from 91% to in the low 70's because he took off the oxygen before he had his tank even close to ready. She was terrified and air-hungry, and it made me furious. Rudeness I can tolerate, but harming my patient I cannot and will not.

[MMARN, BSN, RN]

I'm sorry but that guy is a complete jackass! He put the patient in danger and how dare he question your abilities as a nurse?! That's ridiculous. That lady's O2 stats were unbelievably low! I guess he was too busy patting himself on the back and telling himself he's God's gift than to realize he was jeopardizing the patient. Good job, though I would have let him know exactly what I was feeling right then and there (though, away from the pt), but your course of action is a lot more professional and hopefully will reach the right people.

Edit: I just read the rest of what happened in the situation. I admire your admin's support for you. It's great to have someone on your side. Congrats on taking a stand.