tension between EMT and LTC nurses?

CapeCodMermaid, RN · Apr 6, 2004

Well, that's the order the doc gave me to settle the gentleman down who was attacking everyone within 3 feet of him......so I sent him out....per MD order.
Once they got the guy relaxed the antibiotics and fluids were given, but he was
totally out of control prior....I didn't know he had a uti at the time, we'd only had him a day or so, and he got progressively wild.
IM ativan isn't allowed at the facility I'm at.....so we send them out for seizures.
I don't write the facility rules....nor do I break them. And I give very good care.

I didn't intentionally disparage the care YOU gave. We still have docs who order IM Haldol and we have to tell them that in LTC it is considered a chemical restraint. Docs can learn all sorts of things from nurses...especially about regs in LTC. The hospital here uses Haldol like most people use APAP...talk back once and you get posied and Haldol..then they ship 'em to us and leave us to deal with the side effects.

ImaEMT · Apr 7, 2004

I guess I can count myself as lucky that I haven't run into this tension you all refer to....or the EMT's being rude to patients or family. We are a rural community with 32 volunteer EMT's and I can tell you that each and everyone of us is dedicated and caring. I have never worked with one that has been rude to a patient. I have been the patient once myself ( MVA) and had only great care from the medics. Our LTC's are often severely understaffed with RN's. One facility only has 1 RN for each shift, with CNA's 9 no LPN's), and they call us frequently for ill residents. Yes, sometimes we roll our eyes when we get called for a patient who apparently has no symptoms ( and gets released from the ER an hour after admission). But, we understand that the singel RN has ALL these patients with no help, and if someone gets severly ill on her shift, she's SOL! Better to call us than to let it go.

Our only problem has been with LTC that don't define code status clearly. Got called to a patient in a "full code". Arrive and find her sitting in a chair, talking and laughing. Vitals hadn't been done. No assessment by LPN/RN. We had assumed "full code" was an PNB...instead they meant she wasn't a DNR. I think that' s been cleared up now.

I'm sorry for all of you with such bad experiences! We have very clearly defined roles in our ER and in our community. We have a lot of respect for eachother. Oftentimes, the RN will call one of us to do a hard IV start, or vice versa. As far as knowledge base goes....there is a big difference. EMT's are trained to save a life RIGHT NOW! RN's are trained to care for a patient long term...through the life span, in addition to acute skills. EMT's know how to properly assess, treat and stabalize a trauma patient IN THE FIELD. So different than in the ER where everything is dry and warm. Our ER RN's all atest that none of them would have a clue how to deal with a mass trauma in the field. That's our job.

Good luck to you all. I hope your EMS systems get better

Lisa

redhd5 · Apr 8, 2004

I had a situation in LTC where the ambulance was called to send a resident to the hospital per families request. Dr. wanted the guy seen to resolved respiratory distress issues, and it was on a Sunday, and our portable x-ray guy takes Sunday off (there are three major hospitals in my area). The family wanted him sent, and then didn't want him sent to the ER. The family wanted to paramedics to monitor the guy at the bedside and stick around for a few hours. When I came in that a.m., I could not believe that no one ( nurse or paramedic) had taken charge of the situation. The paramedics were standing around acting impatient, and the guy really needed to be sent. So, I pulled the family aside, and explained that the resident needed to go to the ER to be evaluated by the MD and that he would probably return that day. I told them that the paramedics could not sit around and wait, as they were the EMS for the entire community, not just this particular resident. I told the son that if he didn't want his dad sent, then the paramedics would be leaving, and when they made up their mind to send him, we would call them back. The family decided to let him go to the ER at that point. (He had pnuemonia and was started on i.v. antibiotics and returned to the facility.)

I have only witnessed one rude EMS worker. Everyone here is really great to work with. I even walked in on a situation where two nurses were doing CPR on a dead lady (obviously gone for awhile) and the paramedic team was professional and courteous. They instructed the nurse to call the MD and the coroner, ran an EKG strip for the nurses, and were very pleasant. I was surprised, because I thought they would get nasty with the nurses for that.

The only time we don't treat and send is for residents who are comfort care, and the family is given our written policy prior to making that decision and a staff nurse or social service person worker goes over it with them. And "comfort care" is an order from the doc, so there is no gray area.

I find that a lot of residents have a hard time with the code/no code choice, mostly due to the way it is explained to them. I try to keep it simple.

(Coroner or 9-1-1, people!)

acgemt · Apr 8, 2004

I can see both sides as I have been an EMT for 6 years and am also entering into the nursing profession. No matter what your personal opinion or grudge, you have to remember one thing. We are all here for one purpose...to treat the ill and injured. The patients come first!

aurora_borealis · Apr 8, 2004

I once worked in an LTC facility. One day, a fellow nurse asked me to check the BP of an employee who came to the clinic due to "dizziness." The nurse couldn't get a BP, and neither could I. I checked the pulse, which was over 200. We put her on a cardiac monitor and I immediately recognized SVT, so we called 911. They arrived promptly and, despite their initial complacency, soon realized this woman was in SVT and couldn't find a pressure. She needed an IV but they couldn't get one, as she was basically shutting down. Having much experience in starting IV's I offered to try, fully expecting them to tell me to but out. But they didn't. So I stepped up to the plate, palpated for veins that anatomically are supposed to be there, and voila! Were they impressed, you betcha. And they took her to the hospital. The downside of this? My friend got in trouble with her NM (thankfully she wan't my boss) and publicly chastised her for calling 911 instead of notifying the poor woman's husband to take her to the hospital.

CapeCodMermaid, RN · Apr 8, 2004

Coroner vs 9-1-1???? Do y'all know the statistics on successful codes in the HOSPITAL never mind in an LTC? What makes us nurses nutty is when the social worker asks the family if they want their family member to be rescusitated...put that way of course they would say yes...should be phrased "Do you want us to ATTEMPT to rescuscitate your family member?"

NurseOtter · Apr 8, 2004

I do not know you, and I don't care to know you.

I have been a Paramedic for over 10 years, and a RN for 1 year. I have seen both sides of the fence. Paramedics get disrespect from nurses, and nurses get disrespect from paramedics. It is a game that has been played for years. Your post is horrible. The "hierarchy" is NOT RN then Paramedic. RNs are not above Paramedics and Paramedics are not above RNs. In an ambulance or out in the field, the Paramedic is in charge over the RN. Period. In a hospital setting, Paramedics cannot take orders from a nurse, and a Nurse cannot take orders from a Paramedic. You need to learn a little more before you post. Spelling and punctuation may also help.

Blackcat99 · Apr 9, 2004

:chuckle Nurse Otter

Do I detect some hostility in your post? :rotfl:

LPN2BSN · Apr 9, 2004

When I was taking my EKG class, a paramedic taught is. He tells me "Your to smart to be a nurse"...like WTH is that suppose to mean? :angryfire On the contrary, sometimes I feel to stupid to be a nurse. I'm sorry but I like giving care to someone though out the day, not just picking them up and dumping them at the hospital for someone else to care for.

Luckily I am friends with several EMT's and the ones I know are truly awesome people who are totally respectful of everyone.

PA-C in Texas · Apr 9, 2004

Man it really pains me that so much animosity exists, but when people make comments about hierarchy with the RN at the top, it is easy to see why.

You know, nursing school always seemed like somewhat of a 2-year sorority indoctrination where they teach you a little pharmacology, some patient assessment, nice little skills like bathing a patient in bed, etc.

Well I decided to test myself and try to get a better feel for it, so I started doing a few guest lectures on emergency medicine for nursing students. Yeah, I still think they could be teaching a lot more science instead of so much stuff about "delegation" and "being a member of the profession", but it is not my place to say, and it DEFINITELY wasn't as bad as what I had originally thought.

For those of you who make disparaging remarks about EMS, I encourage you to try and find out a little. "They simply memorize on protocols" and other similar quotes are simply not an accurate depiction of EMS and those who make them only demonstrate their ignorance. In fact, about 65% of all the calls for the services I have worked for were not emergency calls, and about 95% of them involved no adrenalin rush.

You know what the newest EMS protocols are like? Simple authorizations to use medication and advanced procedures such as "Cardizem may be administered for supra-ventricular tachycardias arising from enhanced myocardial automaticity or refractory re-entrant mechanisms. Usual dose: 0.25-.035 mg/kg slow IV push." or "Intravenous catheterization may be performed on any patient who would benefit from said procedure, based on the Paramedic's judgment." Do YOU have standing orders that are that liberal? When you say something like Paramedics only memorize protocols, it is really easy for them to say something like, "Why don't you go mind your foley catheters and 1500 calorie diets while I go review my surgical airways." Not very flattering, is it?

Do you cringe when you hear about the full code at an LTC in a wheelchair with a NRB @ 2 lpm like I cringe when I hear about GOOD nurses being degraded?

The things is, don't judge lest you be judged. I don't go around telling people that I think nurses are a waste of good money, that they are all *****es, and their education is basically a worthless 2-year seminar on joining Lambda Kappa Psi, because I don't want people telling me that PA's are worthless individuals who couldn't get into medical school and who want to play but not do the time, and always go around pretending like they are doctors.

I don't think that about nurses, and I hope that they don't think that about PA's, but I simply don't make it a habit of degrading other people's professions. The truth is, that aside from physicians and paramedics, I don't know everything that RN's, RT's, Radio Techs., Dieticians, and everyone else do in the normal course of their jobs, nor have I been through their education. Sometimes I think when people get in turf protectition mode, they are only really fooling themselves.

telenurse04 · Apr 9, 2004

This topic actually came up in my RN-BSN program class yesterday. It was the tension between nursing in general and paramedics. The bottom line is yes there is some tension and it needs to be recognized. But, the reason for it is that EMT stuff and nursing are two different diciplines. If you put a floor nurse in a helicopter, they would be lost. If you put an EMT on a floor, they would be lost. Each has skills the other does not have unless specially trained. If it wern't for a friend of mine that is a paramedic, I probably wouldn't be a cardiac nurse of which I really love. To make matters worse, I think EMT's would find LTC harder to understand than any acute care setting. About the comment with regard to know all the patient's past history and dx to tell the EMT. No, LTC nurses don't know all that because they have what 40-80 people to know and take care of. Knowing that info takes a lot of time!! And, I don't think nursing homes emphasize patient hx as much as they should.

smk1, LPN · Apr 9, 2004

for anyone who thinks that nursing school is just a "2 yr sorority" and implies that paramedics are more extensively educated ie the comment about nurses minding their "foley catheters and 1500 cal. diets vs paramedics looking at surgical protocols" they needs to get a grip. for one thing there are RN's who work in extremely technical fields as well ICU ER MED SURG ETC.... also RN's are extensively trained (differently than paramedics). I'm not going to say what the "hierarchy" is but it definitely is easy to come to the conclusion that the RN would be slightly higher because when you compare the curriculum RN school is longer and with higher level prereqs. (at community colleges) also i don't think there is a bachelors or higher level for paramedics. This is a reason why people might get the impression that paramedics would be "lower" on the totem pole than an RN, not saying its true but just giving a reason. Paramedics are wonderful edcuation providers in a specific capacity, and yes they should know more about emergency services than the average RN because it is their job and not the RN's however if you are a paramedic in an ER then the RN's there most likely will have a wider range of knowledge per their schooling. One is not "better" than the other. Paramedics have a tough job, but so do nurses, they don't spend all day looking at diet plans, wiping butts and doing personal care just as paramedics don't spend all day practicing "cookbook" medicine. lets Just respect both.