tension between EMT and LTC nurses? - page 3

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

  1. by   Betty_SPN_KS
    I'm just a practical nursing student, so I don't have as much knowledge base yet, but I hope to learn much more of what you all are talking about.

    My cousin is a paramedic. (He also wanted to go to nursing school and learn both). He was sharing with me several years ago about the conflicts between ems and nurses not understanding each other and why they do as they do. Nurses learn some stuff about a lot of different things. Paramedics learn a lot about a few things.
    Paramedic school and ADN RN programs are both 2 years here, but each with their own content. EMT courses are much shorter, of course (9 weeks maybe?). Less education, less professionalism, more "attitude"? Of course, this is very individual and not all people with less education would have the worst attitudes. (I hope not, I'm one of those with less education).

    Also, I have a classmate who is a paramedic. He has been very helpful to me as a fellow student because of his knowledge and experience.
    Last edit by Betty_SPN_KS on Mar 21, '04
  2. by   flashpoint
    The biggest problems I've encountered are the ones I mentioned in my previous post. I've also been asked to wait to transport so the CNA can finish shaving the patient (he was BLUE...we didn't wait), I've been directed to a room by a housekeeper and found no nursing personnel anywhere and had to trasport the patient with no information except our assessment. I've had nurses rip the transport packet out of my hands and tell me that the information was for the HOSPITAL, not a bunch of firefighters and I've had nurses scream at me for giving oxygen to COPD patients. I've also been asked to move my ambulance to the back of the facility and bring my cot in through the kitchen (after everyone on the crew dons a hairnet) so that the ambulance in front of the facility doesn't attract attention...the patient was coding in the lobby by the front entrance. Most of my experiences between the ambulance service and the LTCs are positive, but the negative ones sure stand out...it does not, however cause me to lump all LTCs and their nurses into one big negative lump. But...I think that everyone should remember that we all have our places in health care. As a paramedic, I would never think I was qualified to care for my elderly parents as well as an LTC nurse could...neither should she presume to be more qualified than a paramedic when things go belly up. We are trained to treat and stabilize until definitive are can be provided and that is what we do...LTC nurses are trained to provide long term care and that is what they do...both needed and both very different.
  3. by   Betty_SPN_KS
    [QUOTE=cotjockey]The biggest problems I've encountered are the ones I mentioned in my previous post. I've also been asked to wait to transport so the CNA can finish shaving the patient (he was BLUE...we didn't wait),


    I suspect he hadn't been shaved in a while and they were trying to cover their backs? They didn't want to appear to be neglecting their patient? Of course, delaying emergency care for this was much worse neglect.
  4. by   flashpoint
    I don't really think it was neglect...the LTC is known for good care, I just think that priorities were overlooked. I think the nurse tunneled in on the fact that the resident wan't shaved because maintain appearance and dignity is important to her. We tunneled in on his cyanosis because we see people at their worst...no one takes a shower and does their hair before calling 911.
  5. by   Blackcat99
    :chuckle Thanks everyone for your great real-life stories. I have worked as a CNA and an LPN in LTC. If you really want to know what's going on with a patient ask the CNA. A good CNA spends much more time with their patients than the nurses. Unfortunately, most nurses in LTC have 40 plus patients and are unable to spend much time with any patient. If I'm not passing meds,doing treatments or filling out yet another incident report on a patient falling I'm usually on the phone with pharmacy trying to figure out why certain meds -usually narcotics and antibiotics never arrived. If I was EMS I would be asking the CNA what they have observed.
  6. by   smk1
    Quote from lgflamini
    I 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).
    there are several posts in the prehospital forum but in a few of them there are long tangents taken regarding incompetent nurses and how uneducated they were, this is what i was surprised at and the fact that very few if any put in a good word for nurses. and some were VERY disrespectful, making jokes etc...
  7. by   BBFRN
    http://forums.studentdoctor.net/show...hreadid=109596

    Just thought I'd post a link to the thread so everybody else would know what the heck we were talking about.

    Again, I tend to agree with them- if your pt is SOA and desatting, and you call EMS because of that...put some darn O2 on them before the EMS gets there. I saw more of a "why aren't they USING their training?" as opposed to "They aren't trained." And I have worked in a bad nursing home (lasted a whole year there), and have seen some of the things they are talking about- consistently. I was treated like a trouble maker for sending someone out for a GI bleed, was yelled at by the doc after questioning his orders for Phenergan for coffee ground emesis (he didn't want to send this full code pt out), was looked at like I was a nut for calling the doc for a pt with a hemoglobin of 6, etc., etc. When I was agency, I worked in a few awesome nursing homes with much better ratios, and staff/administration that cared about the residents. But it's always the bad ones that are memorable, sadly. Heck, the scenarios I just mentioned took place over 8 years ago, and I remember them.

    I remember being a NH nurse, and letting off steam about things I saw there (at the bad NH). I guess I just feel that they're doing the same thing. I wonder if any of the good NH nurses would feel the same way about some of their co-workers who act like the nurses in the scenarios presented in the SDN thread. The thing is, in a hospital we have a code team to take over, and we assist- we don't wait for the EMS, we are the EMS. So naturally, their stories are going to be directed at NHs or HH in particular- that's who they deal with. If EMTs were as much of a presence in hospitals, they'd see some pretty screwed up things there at times, too. Not just from nurses, but from Docs as well.

    You don't expect the general population to know what to do in a medical emergency, but you do expect a nurse to know what to do. It's our responsibility to keep up on our skills- BLS, ACLS, practice codes, etc. Especially in NHs, where you are the nurse, RT, PT, OT, family member, advocate, and dietician all rolled into 1- for waaayyy too many patients, with way too much paperwork involved in everything you do.

    I tip my hat to the good NH nurses out there (and there are a lot). I couldn't hang in that job and keep my stress level at anything less than extremely high. I don't know how they manage to do all they do on a long term basis. Thank God for them, because it really takes a special person to be able to handle that kind of work.
  8. by   CoffeeRTC
    [QUOTE=lgflamini]http://forums.studentdoctor.net/show...hreadid=109596

    Just thought I'd post a link to the thread so everybody else would know what the heck we were talking about.

    WOW! I just read thru that link. How offensive to nursing homes. Yes I am a LTC nurse, I wasn't the bottom of my class, nor the head and I do have common sense. I have seen many a bad situation in the nursing home and complain just like the EMS have, but never would I generalize like that. There are bad and good in every group. I do feel for the EMS when they come in it some of these bad homes. We have a few nurses where I work that I wouldn't let them take care of my fish :uhoh21: .
    Although I haven't worked as an EMT I did get certified as one and have gone on a few runs with them. Yep... they put up the the same amt of bS that nurses do!
    As far as the debate over sending DNRs to the hospital... as a nurse in LTC we are not the almighty gate keeper... if the resident needs attention and the doc/family/pt wants that done at the hospital...then so be it. Often times if it is something that we can do at the nursing home (Antibiotics, fluids) I suggest letting us treat at the home. But sometimes LTC facilities don't have the full range of services availble after hrs (XRAYs, labs, might be unable to start IVs or have nebulizer supplies ready) so I will send the resident to the hospital for an assessent or treatment....not a cure or heroic measure.
  9. by   hogan4736
    Quote from CCU NRS
    Well I will jump in from a purely observational point of view.

    The problem with sending a DNR Pt to the hospital for care is we can not do anything invasive or take heroic measures either (BLS/ACLS)so the reason they became DNR is so that when they begin to go nothing will be done and if they live in LTC this would like dying at home for them. I understand the problem with families interefering and saying they need to go to the hospital but the second problem is once they get to the hospital an eager resident or ER doc will talk to this greiving family member and explain that we can not do anything as long as the Pt remains DNR and 9 out of 10 time the DNR will be revoked and then a Pt that wanted to be DNR and die peacefully will be fully coded and put on a vent and suffer a long agonizing death. So I am not sure if more education would help at the LTC to explain to families that your loved one wished to be DNR and is now dying and this is like being able to die at home and is what they wanted etc. or if they should let the Pt be sent to a hospital.
    Okay, you keep the pt at the nursing home, fight w/ the family, then said pt dies the next day and then on your days off 3 years from now, you can sit at a trial, be named as a defendant, and go through cross examination...

    DO NOT fight w/ families on this...It's their right, their business, not yours!
  10. by   BBFRN
    Could you be placed in a situation where you had to defend yourself in court, if the patient signed a DNR and was in sound mind when they did it? How does the wishes of the POA factor into this if the patient wanted a DNR, and the family doesn't? I've never had this happen to me- I was wondering if this happens to NH nurses. If this was a possible scenario, I'd probably send them out, too. Let the doctors handle something like that, and give all possible outcomes to the family to at least make sure they're educated on what decisions they want to make- even if they have to get admitted to the hospital to get it addressed.
  11. by   CoffeeRTC
    Quote from lgflamini
    Could you be placed in a situation where you had to defend yourself in court, if the patient signed a DNR and was in sound mind when they did it? How does the wishes of the POA factor into this if the patient wanted a DNR, and the family doesn't? I've never had this happen to me- I was wondering if this happens to NH nurses. If this was a possible scenario, I'd probably send them out, too. Let the doctors handle something like that, and give all possible outcomes to the family to at least make sure they're educated on what decisions they want to make- even if they have to get admitted to the hospital to get it addressed.


    DNR
    Do
    Not
    Rescesitate

    Living Wills ( a little more specific on what the pt wants)

    Sometimes our LTC residents have both but not always... most have a CPR consent or DNR order in their chart (If not they are a full code)

    We all read and know that a DNR doesn't mean do not treat. For example... Say a person has dementia and other medical dx gets a bad UTI or Pneumonia... a few days of IV antibiotics would help and get this person some relief. Lets say the LTC facility isn't able to get an IV in, or doesn't have the drugs or their pharmacy won't be able to get the meds for a day or they don't have an XRAY service who will come out and do a chest on Sat eve. I will send that resident out to the hospital for treatment...Of course I will send all the paper work including living will and code status with them and make sure everyone knows. This is one senario where it is total appropriate to send a DNR to the hospital for treatment.

    How many of us nurses say "I want to be DNR" don't even think about doing CPR on me! Some of us even have the paper work.... soooo does that mean if we get into an accident or maybe need to go to the hospital for treatment of an infection or something we shouldn't get treatment???? No.

    We all have our opinion about what may be best for our pts, but who are we to say... ultimatly it is the pt and family who are legaly able to make thier own decisions.


    Sorry for any typos!
  12. by   Nurse2B73
    Hello everyone,

    I am Shonda and I was interested what everyone was talking about here so I started reading. I am sort of shocked that EMTs were doing this.
    I was an EMT for 8 years and I had friends who were nurses. I have not ever had that kind of encounter but I must say if you got the company name and the unit number for that vehicle make sure you call them and let them know. He could be disciplined big time or even fired. Companies do not tolerate behavior like that. I am taking a CNA course now and the EMTs that show up where we are seem to be ok. If any EMTs were to make in kind of those comments I would let them have it. For the time I have been an EMT I would have never ever created those thought and they should not either.

    I am so sorry that you had to go through that with those idiots. There are some EMTs out there that think they are Gods gift to green earth and they know everything. The training is only 4 months and we learned very basic stuff live give O2, splint, CPR, reports, Glucose, tractions, fractures, some anatomy and explanation of different illness. But when it come to it we basically transport people from place to place. The have to become a paramedic if they want to be more than that. The things they train are things any civilian can do.

    Well take care and I hope that you get the right person and he gets a good discipline action from the company.

    God Bless
  13. by   BBFRN
    Quote from michelle126
    DNR
    Do
    Not
    Rescesitate

    Living Wills ( a little more specific on what the pt wants)

    Sometimes our LTC residents have both but not always... most have a CPR consent or DNR order in their chart (If not they are a full code)

    We all read and know that a DNR doesn't mean do not treat. For example... Say a person has dementia and other medical dx gets a bad UTI or Pneumonia... a few days of IV antibiotics would help and get this person some relief. Lets say the LTC facility isn't able to get an IV in, or doesn't have the drugs or their pharmacy won't be able to get the meds for a day or they don't have an XRAY service who will come out and do a chest on Sat eve. I will send that resident out to the hospital for treatment...Of course I will send all the paper work including living will and code status with them and make sure everyone knows. This is one senario where it is total appropriate to send a DNR to the hospital for treatment.

    How many of us nurses say "I want to be DNR" don't even think about doing CPR on me! Some of us even have the paper work.... soooo does that mean if we get into an accident or maybe need to go to the hospital for treatment of an infection or something we shouldn't get treatment???? No.

    We all have our opinion about what may be best for our pts, but who are we to say... ultimatly it is the pt and family who are legaly able to make thier own decisions.


    Sorry for any typos!
    Oops- i think I need to clarify my original question to mean if the scenario is one of where the pt is a clear case of end-of-life. Not dehydrated, or in need of ABTs. If the patient has signed a DNR, and made their wishes known to the family, can the family's wishes legally take precedence over the patient's in a clear case of end-of-life? With all the litigious family members out there, I'd be taking the safest route possible, too. If that means sending the pt out, and annoying EMTs and hospital nurses, so be it.

    Also, I can see where if the pt was having trouble and the Dr. wasn't available, why a NH nurse would choose to go ahead and send the pt out. I know you guys always call the ER and give them the low down on situations such as that, but us floor nurses don't receive that kind of info, so some of us might make assumptions as to why the pt was sent to the hospital. Thanks for shedding a little light on some of the reasons that we might not have thought about.

close