Bridging the Gap

Specialties Emergency

Published

  • Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

So.... I've gotten it from both sides.

Stupid Paramedics... Stupid Nurses. I recently met a colleague at the EMS station for the first time and she tells me... "Oh you're the nurse? What are you doing here, aren't we supposed to hate each other?" Well, when you get a welcome like that, your only reply can be, "Yah, I think so... because we have more education, right?" She was non-plussed to hear my age old response. Of course, I noticed the gold lettering on her red patch, indicating that she has either a 2 year EMS science degree, or a 4 year degree in any field. Those are the parameters here in Texas.

Why do Nurses in the ED give Paramedics so much crap? Is it because they can perform with perceived autonomy? Is it because they are allowed to "tube people?" Because they are confident in their Code Management? Believe me, Paramedics are not autonomous, they act under standing orders and protocols.

I asked a Paramedic last night why he thought that Nurse in the ED gave us so much crap attitude. He thought it was because she was jealous of our autonomy in the field and the advanced procedures that Paramedics can perform.

I asked him why he thought Paramedics attitudes were so bad and he replied, "I make $11.85 an hour. Why do you think I'm pi**ed?"

I can understand that Nurses in the ED are upset when a medic may have, "missed" something, But have you ever considered that the patients often LIE to us?

We backboarded and collared a 12 year old boy the other week and brought him and his dad in after a 1 vehicle rollover. They both told us that they were "wearing their seatbelts." I couldn't figure out why the kid had a mouth full of dirt. I was slipping the collar under his neck thinking..."Why does this kid have mud in his mouth?" He told us that he, "got out of the and then laid down because my neck hurt." For some reason, he later admitted to the ER Nurse that he and his dad had NOT been wearing their seatbelts and he had been thrown from the car. I only found out because I went back after our next delivery, to ask how he was doing. Silly people... they were rushing to Sonic because of the "free sundae's till midnight" commercial came on. Dad was so excited he rolled his car on the sharp corner.

Last night we brought in a minor head lac. The guy didn't know if he had lost consciouness and then fell and hit his head, or if he fell and hit his head and then lost consciousness. I think he was sleepwalking because of his ambien.

So the Nurse is all attitude about why we didn't backboard and C-Collar him. When we found him, he was sitting upright in his bed, holding a towel against his occiput. He had full range of motion in his neck and spine, with no pain and he got up and walked to the stretcher so we could wheel him out. We have protocols to clear c-spine in the field. Palpate the neck any DCAP-BTLS, any pain? No. Rotate the neck slowly to the left and stop if there is pain, any pain? No. Rotate the neck to the right and stop if there is any pain, any pain? No. Flex the neck and stop if there is any pain, any pain? No. Extend the neck and stop if there is any pain, any pain? No. Ok bud, you don't need a c-collar or a backboard. What is it 3% of patients who are backboarded by EMS actually need it? Wait a minute... isn't that how the doctor clears c-spine? What's the difference? It's not like we made this protocol up, our Medical Control Doctor wrote this policy, we are just following standing orders!

So why the attitude? Is it because EMS brings you more patients when you are tired and burned out? OMG quit torturing EVERYONE and switch specialties!

Maybe i'm a traitor because I wanted to be a paramedic, but a firefighter captain convinced me that nursing was the smarter choice. I still want to be a paramedic, I still want to be a nurse.

I've never understood the schism. EMS is willing to get out there and get dirty to bring them to your technologically advanced, climate controlled and "sterile as possible environment." We are willing to get attacked by dogs and family members to get people to where they need to be. We don't want to bring you that "toe ache," "back pain," "fibromyalgia," "stomach ache," bs call, we know you don't want it, but the system is what it is. We HAVE to transport them and you HAVE to treat them. Did any of us sign up for the abuse? I'm willing to bet no. But we still go to work because we have that common decency. That common denominator of "I thrive on helping people."

Yes, EMS is a young profession, with a wide variety of entry modalities from 4 year degrees, to 6 week medic mills. EMS is trying to get their education requirements on a baseline, where other Alllied Health professions can expect a common denominator or education. Heck... nursing hasn't done that yet... Diplomas, ADN, BSN.

Why do ED Nurses have it in for EMS? I think the answer for the reciprocal is, "EMS gets treated like dirt in the ED and are ill-compensated for what they are willing to do."

signed... GN future RN...next month/ EMT-B future EMT-P...next year

We are all the same team y'all.

Larry77, RN

1,158 Posts

Specializes in Trauma/ED.

I've worked in both kinds of ED's...the kind that don't respect EMS and the kind that socialize with them...currently I work in the latter. The larger hospital's with more BLS crews I think get less respect from nurses...not only because of the BLS rigs but because these Level 1 trauma nurses think their poop doesn't stink and that they can walk across water...trust me I've rubbed hips with them...

I just use the age old "Golden Rule" theory...I treat all people the way I want to be treated...unless you are malingering or drug seeking then...I may not :nono:

mwboswell

561 Posts

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

Can you find me a reference/citation for that "only 3% of backboarded pt's need it"????

mwboswell

561 Posts

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.

Good post.

I work both an NP and a Paramedic.

When I'm working EMS (as a medic), I get treated just like the other crew members; I'm held to the same standards and requirements.

When, as a paramedic, I bring a patient into an ER that I don't work at - they have no idea that I'm a NP; what I try to do is act professional as a paramedic, AND at the same time, I try to help those ED nurses understand that I have an idea of what they are going through during their shift.

I do not try to come into an ER and act like Mr Super Smart Paramedic and put the nurses down; rather I act professional, and with courtesey, I we have no problems.

Guest219794

2,453 Posts

Don't take it personally. ER Nurses who are hosile, condescending, or *itchy to EMS are hostile condescending and b*tchy to everybody. They truly believe:

ICU nurses are nitpicky uptight cranks.

Floor nurses know nothing.

LTC nurses are mentally challenged.

Ancillary staff are incompetent.

Anybody from any other department wakes up in the morning and spends an hour laying out a plan to screw with the ER.

Doctors are idiots.

The nurses you are talking about are unpleasant and unhappy people who see life as a series of conflicts.

FWIW- I have worked in 5 ERs, none of which have had this attitude.

mwboswell

561 Posts

Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Don't take it personally. ER Nurses who are hosile, condescending, or *itchy to EMS are hostile condescending and b*tchy to everybody.

..I believe this is fairly accurate

They truly believe:

ICU nurses are nitpicky uptight cranks.

Floor nurses know nothing.

LTC nurses are mentally challenged.

Ancillary staff are incompetent.

Anybody from any other department wakes up in the morning and spends an hour laying out a plan to screw with the ER.

Doctors are idiots.

...this is highly innaccurate and an inappropriate comment

I have NEVER (13+ years, 8 different ED's, darn near a THOUSAND ED RN's) seen all of those characteristics you laid out. Maybe 1 or 2 of them to one degree or another, but definitely not the paranoid-delusional type...

Your characterization is way out of line.

Katnip, RN

2,904 Posts

It's funny, I keep hearing about the EMS/Nurse wars, but I've worked in two extrememly busy EDs and in both places the nurses and EMS had great relationships. There was a lot of repsect from both sides for what the others did. I guess I got really lucky.

There was always one or two nurses who would get p*ssy with EMS, but then they were that way with techs as well.

8jimi8ICURN

231 Posts

Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

I am happy to see these responses. I've always heard about the rivalry, but when I experienced it first hand, that prompted me to post. That ED nurse did not know that I was a nurse.

Guest219794

2,453 Posts

..I believe this is fairly accurate

...this is highly innaccurate and an inappropriate comment

I have NEVER (13+ years, 8 different ED's, darn near a THOUSAND ED RN's) seen all of those characteristics you laid out. Maybe 1 or 2 of them to one degree or another, but definitely not the paranoid-delusional type...

Your characterization is way out of line.

Yeah, you are right. I don't really know people like this. My point was not to take it personally: Anyone hostile or condescending to EMS is probably not all that nice a person. The condescension is a reflection of an unhappy or insecure person, rather than having much to do with the actions of a given EMS provider.

canoehead, BSN, RN

6,890 Posts

Specializes in ER.

I'm hostile, condescending, and ******, but I've always admired our EMS coworkers. I've smelled some of the patients they bring in and dealt with the family members. I can't imagine going into the home, or trying to get information before everyone has been calmed down and aired out a bit.

SDA3694

110 Posts

So.... I've gotten it from both sides.

Stupid Paramedics... Stupid Nurses. I recently met a colleague at the EMS station for the first time and she tells me... "Oh you're the nurse? What are you doing here, aren't we supposed to hate each other?" Well, when you get a welcome like that, your only reply can be, "Yah, I think so... because we have more education, right?" She was non-plussed to hear my age old response. Of course, I noticed the gold lettering on her red patch, indicating that she has either a 2 year EMS science degree, or a 4 year degree in any field. Those are the parameters here in Texas.

Why do Nurses in the ED give Paramedics so much crap? Is it because they can perform with perceived autonomy? Is it because they are allowed to "tube people?" Because they are confident in their Code Management? Believe me, Paramedics are not autonomous, they act under standing orders and protocols.

I asked a Paramedic last night why he thought that Nurse in the ED gave us so much crap attitude. He thought it was because she was jealous of our autonomy in the field and the advanced procedures that Paramedics can perform.

I asked him why he thought Paramedics attitudes were so bad and he replied, "I make $11.85 an hour. Why do you think I'm pi**ed?"

I can understand that Nurses in the ED are upset when a medic may have, "missed" something, But have you ever considered that the patients often LIE to us?

We backboarded and collared a 12 year old boy the other week and brought him and his dad in after a 1 vehicle rollover. They both told us that they were "wearing their seatbelts." I couldn't figure out why the kid had a mouth full of dirt. I was slipping the collar under his neck thinking..."Why does this kid have mud in his mouth?" He told us that he, "got out of the and then laid down because my neck hurt." For some reason, he later admitted to the ER Nurse that he and his dad had NOT been wearing their seatbelts and he had been thrown from the car. I only found out because I went back after our next delivery, to ask how he was doing. Silly people... they were rushing to Sonic because of the "free sundae's till midnight" commercial came on. Dad was so excited he rolled his car on the sharp corner.

Last night we brought in a minor head lac. The guy didn't know if he had lost consciouness and then fell and hit his head, or if he fell and hit his head and then lost consciousness. I think he was sleepwalking because of his ambien.

So the Nurse is all attitude about why we didn't backboard and C-Collar him. When we found him, he was sitting upright in his bed, holding a towel against his occiput. He had full range of motion in his neck and spine, with no pain and he got up and walked to the stretcher so we could wheel him out. We have protocols to clear c-spine in the field. Palpate the neck any DCAP-BTLS, any pain? No. Rotate the neck slowly to the left and stop if there is pain, any pain? No. Rotate the neck to the right and stop if there is any pain, any pain? No. Flex the neck and stop if there is any pain, any pain? No. Extend the neck and stop if there is any pain, any pain? No. Ok bud, you don't need a c-collar or a backboard. What is it 3% of patients who are backboarded by EMS actually need it? Wait a minute... isn't that how the doctor clears c-spine? What's the difference? It's not like we made this protocol up, our Medical Control Doctor wrote this policy, we are just following standing orders!

So why the attitude? Is it because EMS brings you more patients when you are tired and burned out? OMG quit torturing EVERYONE and switch specialties!

Maybe i'm a traitor because I wanted to be a paramedic, but a firefighter captain convinced me that nursing was the smarter choice. I still want to be a paramedic, I still want to be a nurse.

I've never understood the schism. EMS is willing to get out there and get dirty to bring them to your technologically advanced, climate controlled and "sterile as possible environment." We are willing to get attacked by dogs and family members to get people to where they need to be. We don't want to bring you that "toe ache," "back pain," "fibromyalgia," "stomach ache," bs call, we know you don't want it, but the system is what it is. We HAVE to transport them and you HAVE to treat them. Did any of us sign up for the abuse? I'm willing to bet no. But we still go to work because we have that common decency. That common denominator of "I thrive on helping people."

Yes, EMS is a young profession, with a wide variety of entry modalities from 4 year degrees, to 6 week medic mills. EMS is trying to get their education requirements on a baseline, where other Alllied Health professions can expect a common denominator or education. Heck... nursing hasn't done that yet... Diplomas, ADN, BSN.

Why do ED Nurses have it in for EMS? I think the answer for the reciprocal is, "EMS gets treated like dirt in the ED and are ill-compensated for what they are willing to do."

signed... GN future RN...next month/ EMT-B future EMT-P...next year

We are all the same team y'all.

I totally agree! I cant believe someone hasnt posted this already. I think that (not all) but SOME nurses lash out on EMS because they become frustrated dealing with patients, family members, and doctors who can be disrespectful and maybe they look for someone that they can take it out on like PCA's (except they have to work w/ them) and EMS?? I dont know... this is just what I gathered from the nurses I worked with during my clinical rotation in the ER.

8jimi8ICURN

231 Posts

Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.
can you find me a reference/citation for that "only 3% of backboarded pt's need it"????

honestly, i was quoting my lead instructor. but i found this for you:

http://www.jems.com/news_and_articles/columns/bledsoe/bledsoe_top_10_ems_studies.html

hauswald m, ong g, tandberg d, et al: "out-of-hospital spinal immobilization: its effect on neurologic injury." academic emergency medicine. 5(3):214–219, 1998.

the university of new mexico (unm) school of medicine has an excellent department of emergency medicine. in this study, one of their faculty members, mark hauswald, performed an interesting study. dr. hauswald retrospectively reviewed all cases of prehospital spinal immobilization brought to the unm medical center over a five-year period. then, these were compared with cases from a similar hospital in malaysia for the same five-year period.

interestingly, spinal immobilization is very rarely, if ever, used in malaysia. in fact, most nurses and physicians in malaysia could not recall ever seeing a patient with spinal immobilization applied. surprisingly, the researchers found there was less neurological injury in the malaysian patients (who were not immobilized) when compared with the patients in albuquerque (who received state-of-the-art immobilization).

they concluded there was less than a 2% chance that prehospital spinal immobilization had any beneficial effect.

not quite comprehensive of the u.s. like my statement implied.

and the study is over 10 years old.

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