tension between EMT and LTC nurses? - page 2
i was reading some of the prehospital forum on a different medical board hoping to get some info and insight into their job because if there is a lag time between finishing my rn prereqs i have been... Read More
Mar 20, '04Quote from psychomachiaAgnus expounds: FYI the hiarcheal order is RN then Paramedic then EMT.
Me: And FYI "hiarcheal" is usually written as hierarchical. Also, there are some who would argue the order should be MD--->God--->Midlevel practitioners (PA/NP/CRNA)--->RN---->LPN---->CNA.
There are also other branches from above God where you have Firefighters and everyone else below them. Another branch starts above God where you have Police Officers and, of course, everyone else below them (the Police and Firefighter brances are often in mortal combat for the elusive taxpayer dollar and have to align their forces in conjunction with political candidates who, of course, are above God but under the Devil.
Branches usually do not intersect as you have suggested. This may occur on a forum, such as this, when the debate over who should work in an ER (paramedic vs RN) and who should be the supervisor of the other's actions, but these are only "pseudo-branches" as they are often just the cogitations of "internet experts" who like to tell stories about their first hand experiences in dealing with the other brances. Thus, the RN vs paramedic battle is usually fought in the small minds of those who often have never worked both jobs, yet think they know all about the other because they spent a few hours in a firehouse or an ER.
Your command of and is a challenge and I had difficulty trying to grasp your somewhat rambling ruminations.
As an RN I'm not impressed with your hypothetical argument of emergency care being "one narrow focus," since emergency medical conditions can be very broad based. Perhaps what you meant was the focus of the paramedics training is on the initial identification of life-threatening conditions and their treatment with stabilization until delivery to an Emergency Dept. You can argue that "definitive" care starts in the hospital, but if all you get are dead bodies...well...might as well call yourself the morgue.
As a paramedic, I'm very impressed with how poorly you make your argument which rings of jealousy from not being able to ride around in the big red trucks with the lights and sirens on. Listen, if you want I'll help you get your paramedic certificate and then you too can join us at the firehouse for a little BS session as we kick back in the La-Z-Boy recliners and eat ice cream...but don't think for a second you get to hold the remote control...
Typical arrogance. I respect EMS. I think their jobs are tough, interesting, and require a great deal of knowledge and skill, as does mine.
I wish that some rude and arrogant EMS whom I've had the misfortune to come in contact with would reciprocate this repect.
I find that female EMS are a lot nicer to deal with.
Mar 20, '04I live in a rural community that runs an active EMS crew. We have 4 full-time EMT's and numerous volunteers who work various hours. I've been an EMT for quite some time and cannot ever remember there being tension between our staff and the LTC community. We take every call the same, whether it's a LTC transfer, a cardiac emergency, or a trauma call, it's all run the same. We have a short transfer time to our closest hospital, so an entire background on the person's medical history would probably take longer than the transport itself. We get what we can get when we can get it and we go from there. Whether that is a verbal report or a copy of their chart, we just take it and go so we can work out the details later. I'm sure bigger cities don't work the same as we do. We aren't so busy as to look down on LTC transfers, and it doesn't matter whether there is a DNR or not. So please don't lump us EMT's all in the same group. There are some pretty cocky medics out there who work in the busier areas and see LTC as an inconvenience to them, but we take all calls seriously and never criticize or condemn anyone for calling 911. That's what we are there for, and that's what we do (especially those of us who volunteer). This just gives another side to the argument of whether or not tension exists, and it may just depend where you are and how busy your EMS service is.
Mar 20, '04The LTC that i do PRN shifts at doesn't seem to have this problem. Six of the nurses met their husbands there. The husbands were the EMTs that picked up residents lol.
Mar 20, '04:chuckle Wow! That's nice to hear that some nurses and EMT's got married!
Thanks CCU NRS for clarifying your position in regards to DNR.Yes, what is the sense of sending them to the hospital if they are going to die in a few hours?. You are so right about the importance of everyone being aware of the DNR status of a patient. I have heard of "horror stories" where patients have ended up on ventilators.
Mar 21, '04As a paramedic, I expect certain things when I walk into an LTC to tranport a patient. If it is an emergent transport, at the very least, I expect to be told why I am transporting the patient...I want to know if they fell or are having chest pain or whatever. I expect a NURSE to be there to give me at least a little report...not a CNA, not the family member, not the patient's roommate, but NURSE...I don't always get that. I would also like a copy of the resident's med list and face sheet and something with their primary diagnosis...it really helps me out while we are transporting. It only takes a few minutes to make the copies and it doesn't take a nurse to make them. Yes, you are going to feel my frustration, if I don't have at least minimal information on the patient. I know we treat patients without a bit of information about them all the time, but when our patients come from a health care facility, I expect a little more and your residents deserve more than the patients we pick up from the streets. I also expect someone to be near the facility doors when the ambulance arrives. Someone needs to direct us to the resident's room...again, it doesn't have to be a nurse, but I shouldn't have to get my cell phone out and call the LTC while I stand in their lobby in order to get a staff member to direct me. If I have to do that, you will probably feel my frustration.
For a scheduled transport, I expect the resident and their paperwork to be ready when I arrive. If the ambulance service knows about the transport 24 hours in advance, the LTC knows about it 24 hours in advance...don't waste my time by having the resident in the middle of a shower or by not having their paperwork ready.
Also, don't assume that because we're volunteers that we don't know what we are doing...we don't need to be told that we can only turn the O2 up to 6 by cannula or that we need to check for peripheral pulses after moving a hip patient...we are professionals, just like you. We'll treat you with the same respect that you treat us.
Mar 21, '04I saw the thread the OP is talking about on SDN, and I didn't feel the EMS posters were being disrespectful. They had some legitimate complaints, actually. I think I would feel the same way if I were them. (Don't flame me, please).
Mar 21, '04:chuckle Hey lgflamini
We see you hiding under that chair you coward lol. Don't you know that's the fun part (being flamed) after you give your opinion? :hatparty:
Mar 21, '04I can honestly say that in my years of nursing, NO ONE has treated me with less respect than the EMT's. In HHC, LTC, and in my current clinic environment! Nor in my personal experience, as 2 EMT's came to my home in answer to my EMS call d/t my husband having an MI, asked me what kind of nurse I was, rolled their eyes and proceded to do everything in thier power to disprove my diagnosis. I was right, thier ineptness and grandious attitude was the number one contributing factor to my husband losing 30% of his heart muscle d/t lack of treatment. Problem was, they followed him into the ER and did the care at the ER too! It took me SIX HOURS before someone finally believed me and started his treatment.
I have more stories too, like the HHC COPD patient gone bad, I called, got the attidtude, as usual, they took him only on my insistance, patient died within 24 hours.
Or how bout the kid in my clinic with a BS of 17, they stuck thier head in the door, from 5 feet away, took one look at the kid, and said, you have it under control, he is fine, and WALKED out on me!!! Mind you, I'm in a clinic all alone. No back up, no emergency equipment or medication. EMS is my ONLY backup.
I reported those cases to the head of the dept. They were reprimanded. After my hubby, an entire cardiac program was revised for EMS. I am currently on a first name basis with the dirctor of our large county EMS program, I am continually asking him to help improve the knowledge of EMT's about Nurses and our function. Over the years since I started this fight, in 1995, things have gotten better, but it is a continious fight for respect.
And, yes I agree, the classes that the EMT's took, both prereq and req's are not on the level of the nurses. The nursing requirements are much stricter and of higher levels. PERIOD.
I can only sumise that saving lives and picking up people off the pavement, skews the EMT's perception as to who they are.
OK, EMT's flame me at will but what i have said is the truth of the matter.
Mar 21, '04Quote from lgflaminiCan I borrow your suit???Lol...ya like my flame-retardant chicken suit?
Mar 21, '04Ahh, the age old dispute, "EMS types don't have the education to tie their shoes but nurses are a bunch of overpaid bed changers!" LOL
As someone with several years in both prehospital EMS as well as several years as an ER Tech (and now a nursing student) I've seen the attitude (and I'll admit had the attitude at times) that we're talking about here.
One point we need to keep in perspective is that people don't remember or post about the good things. I remember the calls and the nurses involved to LTC's for the IM D50, the CPR in progress in bed :uhoh21:, the status seizure that hadn't been checked on since EMS was call non-emergent 30 minutes ago, the hysterical "Push Bicarb! You have to push Bicarb!" arrest, the CHF secondary to an unattended IV or the IV start after 12 attempts by the facility because the patient had been double dose on lasix just prior to having the IV D/C'd.
I know I ran a lot of calls with helpful, competent, pleasant, caring, knowledgeable, respectful, conscientious nurses that had all the paperwork ready, had informed the patient they were going to be transported, had called report to the receiving facility, were happy to give me report and were pleasant to work along side of. These are not the people that get posted about on the WWW (yes it's wrong, but it's really human nature).
Like Cotjockey said, your residents deserve the best care anyone can deliver. There is certain information available at the LTC that will significantly improve the care your patient receives, pleases share that with EMS.
As far as the comments about EMS personnel being upset about responding to a LTC instead of a trauma, 90% of the paramedic you'll run into outgrew that a long time ago.
I currently work for a Critical Care Medevac Team and our crews are composed of a Nurse and Paramedic. They are this way because the knowledge bases compliment each other.
Long rant but like I said this is the age old debate and we all (nurses and EMS personnel) need to get over it
Can't we all just get along? :chuckle
Mar 21, '04Over the years I have also had several "encounters" with EMS personnel. They are consistently rude to the patient, family and the nurse. I am not sure why they have the sense of superority over nurses, but it has caused the death of several patients I know. I had one incident where I was working an agency shift at a nursing home. I am mainly an acute care nurse, but needed the extra money. Patient fell and smashed his head really bad. Initial assessment showed some minor neuro changes and I felt it best to send him to the hospital for further evaluation. He was a DNR. However, from my perspective, DNR or not, he fell and needed to be seen by a physician. When EMS arrived to the facility, I was giving them report and they took a brief look at the patient and said that he was fine and they would not be transporting him. I told them that if I had to carry the patient on my back, he was going to the hospital. The EMT and the paramedic laughed as if this situation was a joke. By this point, the patient had some significant neuro changes and I was concerned that he had a subdural hematoma and was continuing to bleed. I actualy had to call the supervisor for the Paramedic to get them to transport the patient. Unfortunately, the patient did die at the hospital several hours later, but how horrible that EMS personnel feel like they can play God, just because the patient has a DNR order. I am sorry .... but nurses are better educated and in many cases have a more comprehensive understanding of the patient. EMS just sees a glimpse of what we see and should learn to rely on our assessment of the patient.
Mar 21, '04one time i had the pleasure of an encounter w/an emt whose arrogance, disrespect and total disruptiveness on my floor resulted in my commanding his professionalism and to just do his damn job. the smart ass he thought he was, he turned around and reported me for "delay of treatment" w/my very sick pt. i proved this jerk wrong; his buddies would not stick up for him (they're not all bad) and i have a formal letter of apology from his boss with assurance that he was fired. i would have to say that 85% of my encounters are pretty negative. i don't know how long their training is but basic courteousy should be incorporated into their curriculum.