Horizontal Violence - EMT's and Paramedics VS LPN's and RN's

Medic24 · Oct 17, 2012

As a paramedic I can say that I have encountered nurses that I trust more than doctors. Conversely there seems to be an abundance of nurses in skilled nursing facilities that give nurses the stereotype of being clinically dumb. Example, we were called to a skilled nursing facility for a cardiac arrest. Upon arrival we were told that patient was fine 10 minutes ago. Upon our arrival to room, patient is showing signs of dependent lividity. This doesn't happen to a patient that was fine 10 minutes ago. I am choosing nursing as a career change and am fully aware that these instances are a minority in overall nursing care. I can also say that I have never treated a member of the healthcare team poorly either because it isn't professional.

realmaninuniform · Oct 17, 2012

I think your example demonstrates exactly why EMS seem to think SNF nurses are "clinically dumb". Normal, is a no-no in the nursing realm, especially in relaying report to other modalities. However, our "normal" is anything but normal, especially when it comes to the cognitively impaired, especially on a dementia unit, or really any unit of a SNF. We see these people day in and day out, to the lay person, their behavior seems abnormal, but when you see it everyday and expect it, from the pt. it becomes "normal" for that pt.

It's all a matter of perspective. When you come up on a random call to the SNF, you need to expect just that, random. These aren't your typical acute pts, these are your chronically ill, co-morbidity, often transitional care pts. Also, ALOT can happen in 10 mins, so don't pass judgement, because you really don't know what happened before coming on scene. Pt's in a nursing home can take a turn for the worse in the brink of an eye. Often times it doesn't occur this quickly, but it does happen.

The last pt I sent to the ER was definitely abnormal, even for their h&p and dx's. The squad personnel thought it was a joke and me just trying to get out of doing my job. Turns out that there was something wrong. The pt was in afib, and septic. SNF's are not equipped to make that diagnosis or treat it in time to save the pt. That's why we send them to the hospital.

morte, LPN, LVN · Oct 17, 2012

were you seeing lividity or venous stasis? had a paramedic sic the cops on me. the para was wrong.

As a paramedic I can say that I have encountered nurses that I trust more than doctors. Conversely there seems to be an abundance of nurses in skilled nursing facilities that give nurses the stereotype of being clinically dumb. Example, we were called to a skilled nursing facility for a cardiac arrest. Upon arrival we were told that patient was fine 10 minutes ago. Upon our arrival to room, patient is showing signs of dependent lividity. This doesn't happen to a patient that was fine 10 minutes ago. I am choosing nursing as a career change and am fully aware that these instances are a minority in overall nursing care. I can also say that I have never treated a member of the healthcare team poorly either because it isn't professional.

allnurses Guide · Oct 17, 2012

The EMTs are often no better when they are called to our geri-psych unit.

So, oh yay! A geriatric and a psychiatric nurse!

That's the best of both worlds for those who love to hate!

I have gotten my share of eyeball rolling and heavy martyred sighs, which have made me want to pop someone in the nose... it can be that obnoxious!

BTW...

There was a thread started a week or so ago about a CNA who was laughed at by the EMTs and was told that CNA stood for "Cleans Nuts and A...".

Really?

People need to get a grip.

We all bring something to the table and we all deserve respect.

medic9872 · Oct 30, 2012

I always give a report to the dispatcher when I call for EMS. After they leave with the pt. I also call the hospital to give report. I'm not the nurse who freaks out and calls the doctor over something trivial either, and I always relay that the attending has ordered transport in report. Still the attitudes persist.
I feel I have gone out of my way on every occasion to accommodate, and still they show up with an attitude, and it's not exclusive to any certain company or municipal service. I am always there when they arrive, give them report again in person, and assist them with transferring. All of the paperwork is always neat and organized and ready.
I haven't been so bold as of yet to really chew one of them out on it, but it's getting close.

I am a paramedic and also a nursing student. I've worked in urban, suburban and rural settings for 911 and transport services. Yes, many of my fellow paramedics and emts have attitudes about snf. And no, it's not right. One thing that really jumped out at me in your post was the comment about giving report to the dispatcher and to the ER. What about the medic? The medic deserves the same report that would be given to the ER nurse or to any other nurse you are transferring care to. Just like I would give a report to the ER nurse and also to the snf nurse when the pt is discharged from the hospital. I have had too many nurses (snf and hospital) tell me that "the pt is over there and he's ready, I've already called report." That's great but you have to give ME report too.

The longer I've been in ems the more I see how much more there is to healthcare and to learning in general. I hope you are just encountering a few bad apples. I assure you that not all ems providers behave this way.

As for education, I did all of the core classes for nursing prior to paramedic school. That was two years. Plus a year of EMT school and a year of paramedic school. I have an associates degree and I have taken the same core classes as any adn. And now I am in an adn program. Please don't assume all paramedics are idiots.

And if those ems providers in your area behave badly again, please call their supervisors. Please report it. Ems desperately needs to weed out the ones who are just thrill seekers. You are right in that 90% of our pts are elderly. And they deserve better than the worst that either of our professions has to offer.

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LVNbayarea · Oct 31, 2012

I am a paramedic and also a nursing student. I've worked in urban, suburban and rural settings for 911 and transport services. Yes, many of my fellow paramedics and emts have attitudes about snf. And no, it's not right. One thing that really jumped out at me in your post was the comment about giving report to the dispatcher and to the ER. What about the medic? The medic deserves the same report that would be given to the ER nurse or to any other nurse you are transferring care to. Just like I would give a report to the ER nurse and also to the snf nurse when the pt is discharged from the hospital. I have had too many nurses (snf and hospital) tell me that "the pt is over there and he's ready, I've already called report." That's great but you have to give ME report too.
The longer I've been in ems the more I see how much more there is to healthcare and to learning in general. I hope you are just encountering a few bad apples. I assure you that not all ems providers behave this way.
As for education, I did all of the core classes for nursing prior to paramedic school. That was two years. Plus a year of EMT school and a year of paramedic school. I have an associates degree and I have taken the same core classes as any adn. And now I am in an adn program. Please don't assume all paramedics are idiots.
And if those ems providers in your area behave badly again, please call their supervisors. Please report it. Ems desperately needs to weed out the ones who are just thrill seekers. You are right in that 90% of our pts are elderly. And they deserve better than the worst that either of our professions has to offer.
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He did say he gave report to the medic.

"I feel I have gone out of my way on every occasion to accommodate, and still they show up with an attitude, and it's not exclusive to any certain company or municipal service. I am always there when they arrive, give them report again in person, and assist them with transferring. All of the paperwork is always neat and organized and ready."

realmaninuniform · Nov 24, 2012

Thank you LVNbayarea. This is the exact point I am trying to make. First if I give report to the dispatcher, it is the dispatchers responsibility to relay this to the medic, which apparently they don't do, so I again give report to the medic, then after they leave I call the hospital. That is a total of 3x's giving the same report. These people ought to be grateful for such information. Often times in an emergency situation they don't even know the pt name, let alone medical history, current medications, etc, etc until long after they've been admitted to the hospital. Yet they give me a hard time, and cater to the people who walk into the ED with no insurance, no job, etc. etc. for a "migraine" or "cold symptoms".

realmaninuniform · Nov 24, 2012

As for education, I did all of the core classes for nursing prior to paramedic school. That was two years. Plus a year of EMT school and a year of paramedic school. I have an associates degree and I have taken the same core classes as any adn. And now I am in an adn program. Please don't assume all paramedics are idiots.

This is why I have a problem with medics. They all seem to think this same way. Ooo I took all the same classes, blah blah blah. No, you didn't. You have NO CLUE what it is like to actually work as a nurse, which btw, is NOTHING like they teach you in nursing school. You may have shared a few english courses, A&P, at most, but certainly not the actual nursing clinicals. As for EMT taking a year... You are either lying, or someone ripped you off big time. Regardless of my status as a nurse, I could as a lay person, go through a 2 week course and be an EMT-B. The standard is 3 months, and that's 4-8 hours a week.

jadelpn, LPN, EMT-B · Nov 24, 2012

My EMT course was 180 hours. It varies by state, and those 180 hours can be M-F, just weekends, or a few hours a night. Then you have to not only take a written exam, but you have to do a multi-task set of clinical exams, that is just you and an instructor. And if you do not do everything to protocol, "see ya". Not to mention continuing ed that is a LOT of hours, plus a refresher clinical you have to go and demonstrate competency all which has to be approved. There's no booklet that you read a do tests and you can renew your EMT license, it is really a process of continuing ed that is approved. Or you lose your EMT certification, plain and simple. Parmamedics are specific to both EMT and ACLS with the added "bonus" of intubating someone. They are task specific, however, have a number of protocols that they need to follow, and as an LPN (18 month course of study) who is also an EMT. the 2 protocols are far different. Paramedics in most states need to have some large amount of ER clinical experience. As do LPN's. RN is all of this, plus a lot of theory, which for the EMS system is more protocol based. With all that being said, it is paramount that we all do what is best for the patient, and put egos aside. It is not the nurse's issue that the paramedic believes themselves to be "above" transporting and elderly person. If a paramedic wants all action all the time, then perhaps a huge city is where they need to be. Or perhaps they should become a PA and work in a trauma ER. Part of what we all do is has its ups and downs. However, I really would at this point look at the ambulance companies that you deal with, go to administration as far as the issues you have encountered, and see if you can make a difference by putting "out to bid" specifically what you are looking for in an ambulance company, and go specifically with them. (you could be the one that makes the difference--what is the worst that can happen? They say "nooooo"-?! I would go for it to make changes that will work for the patient).

akulahawkRN, ADN, RN, EMT-P · Nov 24, 2012

As for education, I did all of the core classes for nursing prior to paramedic school. That was two years. Plus a year of EMT school and a year of paramedic school. I have an associates degree and I have taken the same core classes as any adn. And now I am in an adn program. Please don't assume all paramedics are idiots.
This is why I have a problem with medics. They all seem to think this same way. Ooo I took all the same classes, blah blah blah. No, you didn't. You have NO CLUE what it is like to actually work as a nurse, which btw, is NOTHING like they teach you in nursing school. You may have shared a few english courses, A&P, at most, but certainly not the actual nursing clinicals. As for EMT taking a year... You are either lying, or someone ripped you off big time. Regardless of my status as a nurse, I could as a lay person, go through a 2 week course and be an EMT-B. The standard is 3 months, and that's 4-8 hours a week.

Back yourself up to when you first entered Nursing School. There's this set of core courses... called "prerequisites" that had to be taken for entry. While many Paramedics might not have taken the same coursework you did prior to you getting into Nursing School (which prepares you to be a Nurse), many others have. From there, their educational path deviated from yours. Nursing school does NOT prepare you to be a field provider. I have met more than a few excellent Nurses that would be blatantly unsafe in the field, simply because they've never, ever, been educated for that role. Paramedic School doesn't prepare the Paramedic to function in a clinical setting.

Sure, you could take an EMT course in 2 weeks and be certified as an EMT. In 3 months, (more typical), you'd be safer. You could try to get through a Paramedic course and get through their internship, but you could easily fail out because you failed to think appropriately. Paramedic and Nurse thought processes are very different, and have very different purposes in life. I have met my fair share of clinically dumb nurses. I have also met my fair share of Nurses that believe that they're superior to all other care providers, except for physicians, simply because they've been through Nursing School. I have met my fair share of Paramedics that believe they're GODS because they work in the field.

Guess what? I hold a Bachelor of Science in Sports Medicine. Would you like to know why it is that there aren't any significant numbers of Nurses providing care to sports/athletic teams? I'll give you a hint: not enough education. You might find a school nurse being drafted to provide some kind of first-aid care during practices and games at the Elementary or even Middle/Junior High levels. The care they'd render would be sub-standard. If you wanted to work in that field, you couldn't learn everything you would need during a 6 month orientation, and possibly even during a year-long orientation period. Even the thought processes are very different.

Yes, I can take an athlete from pre-season through injury, evaluate the injury, decide whether or not to refer out to a surgeon based on the same exam techniques they'll use, devise an appropriate rehab plan, including a post-op rehab plan, that will take that athlete back to their maximum ability, all while making appropriate adjustments on the fly, all while taking into consideration their psychological needs. When I worked in that field, I got to know ALL of my athletes. All 200-300 of them. I knew their baseline, how they reacted to injury, and could do all the above for the 40 or so that I'd have in my training room at any one time. Oh, and communicate their status to the Coaching staff... in the 15 or so different sports that they played, and had to be familiar with the demands of all those sports and positions within each of those sports.

Do you think you can learn to do all of that, competently, in 6 months? I have yet to meet a Nurse that can, having completed only Nursing School, even at the BSN level. I know of a very small number of Paramedics that can... only because they followed the same educational path I did.

I don't doubt that you're an excellent nurse in your own right. It's horrible that you have had to put up with some transport providers that seem to be less than brilliant. Keep your eyes out for the ones that have a clue. No, they haven't been to Nursing School and aren't Nurses. That's not their job, any more than it is your job to be a Paramedic.

medic9872 · Nov 24, 2012

As for education, I did all of the core classes for nursing prior to paramedic school. That was two years. Plus a year of EMT school and a year of paramedic school. I have an associates degree and I have taken the same core classes as any adn. And now I am in an adn program. Please don't assume all paramedics are idiots.
This is why I have a problem with medics. They all seem to think this same way. Ooo I took all the same classes, blah blah blah. No, you didn't. You have NO CLUE what it is like to actually work as a nurse, which btw, is NOTHING like they teach you in nursing school. You may have shared a few english courses, A&P, at most, but certainly not the actual nursing clinicals. As for EMT taking a year... You are either lying, or someone ripped you off big time. Regardless of my status as a nurse, I could as a lay person, go through a 2 week course and be an EMT-B. The standard is 3 months, and that's 4-8 hours a week.

As a matter of fact, yes, I did indeed take the nursing prerequisites prior to attending paramedic school or even EMT school. Why? Because I was initially headed to nursing school. I was even accepted into a very competitive ADN program prior to attending paramedic school. I declined the spot because I wanted to be a paramedic first. No, most medics do not do this. But some do. Those classes were not required for paramedic school. Many of them were required for the associates degree, which is what I have. And yes, EMT school did take a year. I live in GA and the standard for an EMT is not basic, it's intermediate. And now as of 2012, it's advanced. So yes, in GA EMT school does take a year. And that's a minimum of two days a week with at least four hours of class each day. Some programs have class for eight hours a day, two days a week. That does not include clinicals. I am also a part time EMT instructor. Our students are required to test for their basic (which is available but not recognized by most 911 services in GA) at the nine month point in their program. After they obtain their basic cert, they can go work for a non-emergency transport service if they want. Of course an EMT or paramedic does not do nursing clinicals. They do their own clinicals in many areas. An EMT must do clinicals on the ambulance and in the ER. A paramedic does clinicals on the ambulance, in the ER, peds, L&D, ICU, OR at the minimum. Some also do clinicals at nursing homes or on med/surg floors. It really depends on the program, but there are minimums that must be met. Just like nursing students have minimums that must be met. When you say that all medics think the same and think they have taken the same classes as a nurse, you are being a little ridiculous. Of course they haven't taken the nursing classes that a nurse has. But you as a nurse have not taken the same classes that a medic has taken. You complain about medics having terrible attitudes towards you. Maybe you need to take a step back and make sure that you don't have a terrible attitude toward the medics. Respect is earned, not freely given.

medic9872 · Nov 24, 2012

Thank you LVNbayarea. This is the exact point I am trying to make. First if I give report to the dispatcher, it is the dispatchers responsibility to relay this to the medic, which apparently they don't do, so I again give report to the medic, then after they leave I call the hospital. That is a total of 3x's giving the same report. These people ought to be grateful for such information. Often times in an emergency situation they don't even know the pt name, let alone medical history, current medications, etc, etc until long after they've been admitted to the hospital. Yet they give me a hard time, and cater to the people who walk into the ED with no insurance, no job, etc. etc. for a "migraine" or "cold symptoms".

Actually, it's not the dispatcher's job to give a pt report to EMS. Dispatchers generally dispatch a call over the radio and it's an FCC violation to give personal information over the radio without that person's express permission. Plus that dispatcher probably has more calls to dispatch than just that one particular call. They have to keep up with all of their units, possibly also police and fire units as well, field all radio traffic in regards to each call (en route, on scene, en route again, at hospital, etc) and sometimes answer all the phones for the incoming calls. The dispatcher doesn't usually even want to know all the details of your pt. That's not their job! And no, EMS does not cater to the people who walk into the ED without insurance, without jobs for a migraine or cold symptoms. Most people in EMS don't care if you have no insurance or job. My concern isn't billing, it's pt care. And I treat them all the same whatever their complaint might be.