tension between EMT and LTC nurses?

PA-C in Texas · Apr 10, 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.

Well then you are obviously ignorant. I would point you to the University of Texas Health Sciences Center in San Antonio, Texas Tech University Health Sciences Center in Lubbock, University of New Mexico Health Sciences Center in Albuquerque, etc. as examples of programs in my area of the country. While they might not be as plentiful, your assumption is WRONG.

And I can't speak for the "community colleges" in your area, but it takes the same number of hours to get an Associates Degree in Emergency Health Science as it does an ADN, and the pre-reqs are almost identical. To be licensed in Texas, you must have an Associates Degree.

Wider "range" of knowledge? Yes. However, that range of knowledge does not prepare you to effectively handle an emergency. Your on-the-job training as an ER RN does. So yes, you might know exactly how to bathe your patient while the patient is sitting or write your beloved "patient care plan" while the Paramedic does not.

delta32 · Apr 10, 2004

:angryfire

I am a RN and i work in ICU. For the most part i do think that Paramedics are smarter than most nurse!!! Its not the warm fuzzy stuff you need to know for emergencies but how to fix it. as for someones compliant that they don't have nutrision training..who cares its not like there hanging TPN. Micro: I don't see them analysising microbes, and neither do we , the does it and sends us reports. as for last classes i can't remember what it was.

CapeCodMermaid, RN · Apr 10, 2004

My my my....such hostility here. As I put on my amateur psychiatrist's hat it seems maybe there is some jealousy involved. EMT's get all excitement and nurses just slog along??? Nurses get more respect from docs than EMT's??? Do you RN's spend so much time belittling LPN's? Do the BSN's look down on the nurses with an associate's degree? The patients need ALL of us to take care of them...they need good,smart medically knowledgeable people...

walk a mile in someone else's shoes before you judge them :saint: :saint: :saint: HAPPY EASTER

smk1, LPN · Apr 10, 2004

Well then you are obviously ignorant. I would point you to the University of Texas Health Sciences Center in San Antonio, Texas Tech University Health Sciences Center in Lubbock, University of New Mexico Health Sciences Center in Albuquerque, etc. as examples of programs in my area of the country. While they might not be as plentiful, your assumption is WRONG.
And I can't speak for the "community colleges" in your area, but it takes the same number of hours to get an Associates Degree in Emergency Health Science as it does an ADN, and the pre-reqs are almost identical. To be licensed in Texas, you must have an Associates Degree.
Wider "range" of knowledge? Yes. However, that range of knowledge does not prepare you to effectively handle an emergency. Your on-the-job training as an ER RN does. So yes, you might know exactly how to bathe your patient while the patient is sitting or write your beloved "patient care plan" while the Paramedic does not.

I believe my post said "I don't THINK there are bachelors programs for paramedics" - i did NOT make a statement and if YOU don't know the difference between a personal opinion (thought) versus a statement then who is ignorant here? :rotfl: and no you can't speak for the community colleges in MY area which is what I was posting about and that was ALSO made clear in my post. The problem that i have with your posts is the inherent implication that RN's just handle basic personal care such as baths "beloved care plans" and so on. :angryfire This is where you need to get a grip. This is a nursing board and to imply nursing school is basically a sorority and that the education, training and knowledge are not up to par was uncalled for.

mfdteacher, BSN · Apr 10, 2004

I am a RN working for a large municiple fire department. Part of my duties are to train paramedics and EMTs. One of the reasons that field providers do not like RNs is because we often attempt to help but have no idea what the field providers can and cannot do. How many of us were taught how to hold C-spine on a trauma victim? This is not a nursing function and we don't get things like that in school. Yet in good faith we will stop at a accident scene and try to take over becuase we are a higher level of care. Medics and EMTs cannot function like we do and we cannot function like they do. Can you put in an IV upside down, at night, or intubate a patient?

When it comes to long term care facilities, a lot of them are not staffed by RNs or even CNAs, just caregivers. The medics go to these places on a regular basis and would rather just do their thing than try to listen to someone who does do a difficult job but really doesn't have the background and is part of constant staff turnover. Medics are trained to be aggressive and not wast time and yes they can be arrogant bastards. They will mistake caregivers for RNs and will just be stupid at times. But I don't think we RNs can tar them all with same brush anymore than they can us. Nurses need more education on prehospital care and I am doing my utmost to facilitate this, I even have nursing students doing some clinical time with me to help. Medics need to understand the long term care system and the personnel involved and I'm working on that as well. We all need to be just a bit more tolerant of others and maybe see if we can't compliment each other rather than fight.

Nursie30 · Apr 11, 2004

I'm from a small town too, and the LTC facility I worked at, had always had problems with SOME EMT's. As there are some Nurse Rachetts out there, there are also some EMT's with Ego problems. You may have certain expectations when you pull up to pick a patient up, and expect things to work out just perfect with patient A sitting by the door, and the nurse standing there like Florence Nightengale with paper work in hand. But.....she is probably down the hall with Pt B, who keeps trying to get up and walk after a recent hip fx and keeps falling, and running to Patient C who needs a shot of Haldol to calm his behaviors, and trying to do the med pass so it is within the specified time, while charting on all 20 of her Medicare pts that require full body assessments. The CNA that is supposed to be there so helpfully waiting to show you to the room, is busy laying residents down, or trying to serve out trays and assist feeding residents, giving showers, whatever time it may be. EMT's in our area usually arrive as a team of at least 4, that is more staff than the nurse has that is supposed to have everything just waiting for them to whisk the pt away. What an EMT may see is the nurse isn't at the desk, the phones ringing of the hook and you called us, so come on, but many many things happen in the LTC setting, and usually happen all at once. If it is just a case of a nurse being lazy, then attack that nurse, not all nurses, as you say we shouldn't attack all EMT's. I read the link to the post, and usually don't get involved in these disputes of who is higher ranked, because as many have said, we are all here for a purpose, but the flaming about nurses was uncalled for.

About DNR status, many times a patient will go to the hospital and is a full code, they are asked over at the hosp, and then they may decide to change the status to DNR, that information may never make it back to the nursing facility, but the nurses will get reamed if we don't have the DNR on file and the hospital does. But I think the debate about the CCU nurse is really senseless, DNR is DNR, she has stated she understands that, but comfort measures only is another story. I feel it would be cruel to push the pt out of the nursing home, where the rooms are often bigger, or even more private, their frail bodies, put through so much already, probably hurting with every move that they may make, and where they are surrounded by people and staff that have worked with them from day in and day out, if they are obviously dying.

One more point....I was working at a facility for MR/DD residents and a resident was choking, staff just thought she was having a seizure and did nothing until she fell to the ground and started becoming cyanotic, they then called the nurses in, on the same grounds, not 200 yrds away, in another building was an volunteer EMT, who was also employed at this facility, but was not called in to this situation. He was obviously more equipped in critical care, and opening an airway, but wasn't utilized, and the pt died. So, I guess I am riding the fence here, we just need to have patience for each other, and recognize, the truley arrogant, or rude nurse or EMT, and also recognize the truly caring nurse and EMT. With much love for everyone that has decided to join any health related field, I now sign off.......

mfdteacher, BSN · Apr 11, 2004

Oh yes, I understand the staffing issues. On my off days I work in a large metropolitan ER. I do it to maintain credibility with my guys, but also to keep up, and because I really like patient care. Unfortunately, the guys can't understand our staffing issues. We have waiting lists miles long to get into the fire/ems service and they don't have to put up with half the crap nurses do. Why do you think I'm in this job? I have wonderful benefits, make my own hours, never miss lunch, my boss regularly lets me know I'm valued...I am trying to get them to see the other (our) side but it will take time and patience. I only can hope they will get some empathy out of me so the RNs, LPNs, CNAs, and caregivers won't have to take much from them. But I also hope the system isn't so broken that what we have now isn't the only thing they will see in a career in EMS.

PA-C in Texas · Apr 11, 2004

I believe my post said "I don't THINK there are bachelors programs for paramedics" - i did NOT make a statement and if YOU don't know the difference between a personal opinion (thought) versus a statement then who is ignorant here? :rotfl: and no you can't speak for the community colleges in MY area which is what I was posting about and that was ALSO made clear in my post. The problem that i have with your posts is the inherent implication that RN's just handle basic personal care such as baths "beloved care plans" and so on. :angryfire This is where you need to get a grip. This is a nursing board and to imply nursing school is basically a sorority and that the education, training and knowledge are not up to par was uncalled for.

So since you just don't know, you aren't ignorant? That is the definition of ignorance, but given your poor grammar usage, I wouldn't expect you to know that. You obviously don't read my posts. I said that I HAD believed that about nursing education, but I had taken it upon myself to find out the truth and appreciate what it is to be a nurse.

I really think you have an inferiority complex about what you do, which it totally unnecessary. You realize that you don't have the the skill level as some other practitioners, so instead of realizing that you are valuable and that it is senseless to compare the two, you act like a paranoid schizo and try to believe everyone is out to get you. I don't doubt the usefulness of nurses for one minute, and I have made that clear. I would tell you to get a grip, but I have learned through experience that there is no reasoning with the very insecure.

Here, I'll throw in some of these stupid smileys so my post can appear to be just as much of a joke as yours was..... :angryfire :rotfl: :stone

smk1, LPN · Apr 11, 2004

So since you just don't know, you aren't ignorant? That is the definition of ignorance, but given your poor grammar usage, I wouldn't expect you to know that. You obviously don't read my posts. I said that I HAD believed that about nursing education, but I had taken it upon myself to find out the truth and appreciate what it is to be a nurse.
I really think you have an inferiority complex about what you do, which it totally unnecessary. You realize that you don't have the the skill level as some other practitioners, so instead of realizing that you are valuable and that it is senseless to compare the two, you act like a paranoid schizo and try to believe everyone is out to get you. I don't doubt the usefulness of nurses for one minute, and I have made that clear. I would tell you to get a grip, but I have learned through experience that there is no reasoning with the very insecure.
Here, I'll throw in some of these stupid smileys so my post can appear to be just as much of a joke as yours was..... :angryfire :rotfl: :stone

first off you have no idea whether i am a nurse or not so your assumption, if proven wrong by your usage of the word ignorance, would also include you. You have made posts on this board in more than one thread that leave the impression that you feel nurses are inferior. Comments such as go back to "checking your foley catheters and 1500 cal diets" "nursing school is little more than a sorority with a little pharmacology thrown in" "take care of your baths and precious careplans" "your associates degree does not give you the right to question my MEDICAL decisions" , you see these are the things that make one ponder what you really think about nurses even though you are sure to put in the nice backhanded compliment once in awhile to seem legit. I am not going to fall to your level by insulting you personally as i just have no desire to harken back to junior high. Who cares about grammar on a BB anyway?! :rolleyes: As for feeling inferior I can assure you that I feel just fine but thanks for the concern. :rotfl: you seem just a BIT upset by my post. I wonder why that is? was I way off base? hmm? nah probably hit the nail right on the head. Your condescending attitude was as clear as day and i chose to call you on it.

aurora_borealis · Apr 11, 2004

Frankly, I think much of the tension between nurses and paramedics is territorial, and because both parties go on the defense. Every paramedic I ever dealt with, professionally and personally (my elderly neighbor fell about once a week and since she was dead weight I frequently had to call the fire department to help me get her up. I felt bad about it because I felt I was wasting resources, but it was either that or leave her on the floor) Even though they knew I was an RN, as my neighbor always told them, they appreciated my input as to what was going on with her. If you realize that the goal is the patient, and not our egos, you'd be surprised at how well the two disciplines can work together. What I hated when I worked at an LTC was when I had to call 911 knowing full well it wasn't necessary, but protocol demanded it. Point in case, we had a resident who fell and injured her shoulder, and she obviously needed to go for xrays, etc. But did she need 911? Absolutely not. Even she didn't want us to call them.I tried to convince administration to have one of the security guys to take her to the hospital, a whole mile away, but to no avail. So I called 911, feeling like a total jerk. When they got there I apologized profusely (out of earshot of the patient) for wasting their time and resources. They were very gracious about it, knowing it wasn't my decision.

Lastly, the hospital where I used to work had a policy about restarting any field IV within 24 hours of admission. The ER's policy was not to do it in the ER, so as not to insult the paramedics. I alwyas thought it was because they didn't want to bother, not that I blame them.

PA-C in Texas · Apr 11, 2004

Well let's just examine these ad hominem attacks. Do I think nurses are inferior to me? Personally, no. As far as their education level? Yes. Level of care they provide? Yes.

Like I said, never try to reason with the very insecure. I also love how you twisted my words to suit your own purpose. So even though you seem to be verbally incontinent, you do seem to be smart in a conniving sort of way.

Do I think Paramedics provide better emergency care? In general, yes. If you took a new Paramedic graduate and a new RN graduate, I would take the paramedic any day.

Do I think Paramedics are more educated? No, not per se. They obviously practice at a higher skill level, and are trained to handle just about any sort of medical emergency, but emergency medicine does not encompass everything.

Yes I respect nurses, but when they start beating their chests and try to put other professions down, I am happy to remind them about their OWN profession.

BBFRN, BSN, PhD · Apr 11, 2004

Why is there tension between nurses and EMTs? Because of nurses and EMTs, and the general lack of knowledge about what the other does in any given capacity. Some nurses are ACLS certified, can start an IV in the dark, and can intubate, hold cervical traction, etc...some can't- they have a different skill set which is IMHO equally important.

Where I work (level 1 trauma), there is a collaborative effort in patient care between EMTs and nurses, because almost every patient comes in with multiple traumatic injuries. Nobody questions the importance of the other...why would we? We as nurses there don't need to know the details of the EMT's education- they have stabilized a very messed up MVA victim, stabbing/shooting victim, etc. If they hadn't done what they do, the pt would have been DOA in a lot of cases. They deserve much respect for that. There's collaboration with the flight nurses, EMTs, etc. as well. Because it's necessary with this pt population.

It's our function as nurses to help the pt get better- yes. But if the EMT hadn't performed their function to stabilize the pt in an emergency situation, the pt wouldn't be alive in the first place. Maybe it's just a difference in perspective related to what kind of area of nursing one works in. I'm just kind of confused as to how some nurses can complain about EMTs not respecting us and what we do, while disrespecting EMTs and what they do. Yes, EMTs have more autonomy in what they do than a LTC nurse- there's a reason for that, and thank God they do. Why else would you call them, instead of calling the Doc to come in? Who cares about the details of their education??? What they learn and know saves lives- that's all we really need to know. Give them enough respect to do what they see needs to be done, and give them the info they need to do their jobs. Why would anybody have a problem with that? If you were in respiratory distress or having chest pains, what would you do? Call another nurse, or call an EMT? It can be as simple as that. If you can trust them enough to save your butt when you need them, why not allow them to save your pts too? Without ego getting in the way. I guarantee all of this would be a non-issue if it were you on the stretcher. Would it matter how "caring" they were at that point? Not for me- I'd be like, "Thank God you're here- now do your thang."

As far as changing field IVs- we don't do that very much where I work for several different reasons that someone in a different area of nursing might not know about. With MVAs that possibly have multiple fractures, or even a femur fracture for example, and EMT knows that pt is going to need at least a 16 gauge IV to get some fluid replacement sqeezed into the pt before they go into shock. They are also going to need lots of blood, etc. after they come to us. Are we going to change to a #20 and hope the blood gets in them, or are we going to keep the #16, etc. that they might need? Just because you don't know why they've put in a #14 or 16 doesn't mean they didn't have a darn good reason for doing so, based on what they know and what they can reasonably expect to happen to the pt.

We as nurses for the most part pretty much know what we're in for when we get a pt. EMTs however are educated in determining those things for themselves in the field. That takes brains, acute assessment skills, and knowledge.

I'd get pretty ticked, too if I was answering a call to a place where the info was available when I got there, but wasn't given. I'd also get ticked if I was told by someone who doesn't know the extent of my knowledge that I was uneducated and just merely trained to know a few protocols. If some of you other nurses think those protocols are BS, then go get your ACLS and PALS and see just how much you learn from those 2 certifications alone. Ya still have to use your nut to follow those protocols. I can understand most of the EMT's complaints. Give them enough respect to at least empathize with their frustration at being told they're basically trained monkeys who memorized some protocols. Don't we as nurses get the same attitude from the general pop. and some med students at times?

Sorry for the novel...lol.