tension between EMT and LTC nurses? - page 10
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
Sep 15, '04Joined: Apr '04; Posts: 4I unstand what you're saying and respect your opinion. As a Nurse and a Paramedic I hear it from both sides. There are stupid, ill trained, arrogant Paramedics AND Nurse. No one profession holds the corner market. As for who's better... Neither. Different doesn't mean better or worse..it means DIFFERENT. As far as taking a nurse over a Paramedic any time...that depends on the situation. If I'm in a bad car accident and need an emergency airway, PLEASE send me a Paramedic. On the other hand if I'm in a hospital and need nursing care PLEASE send a nurse.
Quote from Jailhouse RNEMT/Paramedics and LTC nurses have vastly different roles. The RN has a clear knowledge base superiority. How ever it must be understood that these two groups of people serve very different functions. How ever to the EMT/Paramedics who think you are so much better educated, listen to your radio when getting medical direction.....It is in many cases an ICU/CCU/Trauma based RN/NP that is giving your the direction you require to do your function. I hope they don't want to try and take on Corrections Nurses.
PA-C in Texas you have some things to learn. First you need to change your attitude. What are you doing in a nurses forum anyway? I have worked as an EMT/Paramedic and as a flight nurse. I was a nurse in the Army and privilidges beyond any Paramedic. You cannot contrast people who work in different environments. A Field Trained or RN/Flight Nurse is better able to function and is more independent than a Paramedic. Just a little food for thought.......I'll take the nurse any time. Kind of like I want an MD not a PA. Who there is better trained?
Sep 15, '04Occupation: House Supervisor, Night Shift. Specialty: ICU/CCU/CVICU/ED/HS ; Joined: Aug '04; Posts: 231; Likes: 145Quote from LmoynihanI have spent a loooong time reading this thread...and...I have decided that there will ALWAYS be emnity between EMS and Nurses...or, lest I offend any one...Nurses and EMS...I would like to say that they are two different schools of thought. Or you could say two different disciplines. The 'medics are taught/trained to react to a situation, yes, we have protocols and algorhythms(sp?) to go by, byt we have to deviate once in a while...So...We are not just "trained"I unstand what you're saying and respect your opinion. As a Nurse and a Paramedic I hear it from both sides. There are stupid, ill trained, arrogant Paramedics AND Nurse. No one profession holds the corner market. As for who's better... Neither. Different doesn't mean better or worse..it means DIFFERENT. As far as taking a nurse over a Paramedic any time...that depends on the situation. If I'm in a bad car accident and need an emergency airway, PLEASE send me a Paramedic. On the other hand if I'm in a hospital and need nursing care PLEASE send a nurse.
Nurses, are taught to think beyond just the primary "diagnosis" and to look at the "at risk for" problems. So, what we have, IMHO, is a case of "apples v. oranges."
Sep 16, '04Joined: Sep '04; Posts: 120; Likes: 9Quote from HeadhurtI was at one of my night classes at the college tonight. Down the hall they are having an EMT course and one of the instructors (I have to admit) is a pretty good-looking, well-built guy. As I was walking into the class this instructor was out in the hall in his EMTMaybe the EMTs are just hacked off because it is not a trauma case that most tend to thrive on. Either that, or they have some sort of inferiority complex that they are working through.
Don't worry...EMT's are equally rude to their patients. I was in an accident, my face badly burned, blind as a bat. I was in extreme agony, and when I asked for something to put on my face, I got yelled at by the EMT for being impatient. Well, EXCUSE ME BUTTHOLE, BUT IT IS NOT YOUR FACE THAT FEELS LIKE SOMEONE THREW ACID ON!!!
"costume":chuckle ....anyway, I see these two giddy freshman girls giggling away and turning mushy...this EMT was eating it up, strutting around like a banty rooster (as annoyed as I was, he sure could strut... )
Ahem...but anyway, I have not really had any run ins with EMTs in LTC. So far when I have had to call the ambulance they have been pretty friendly, though I do work in a small town. Could have something to do with it.
Sep 16, '04Joined: Jan '02; Posts: 5,673; Likes: 159I suspect the disrespect is actually jealousy due to pay discrepancies...as many EMT's think they are more valuable than the average nurse. JMHO.
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from AgnusFYI the hiarcheal order is RN then Paramedic then EMT.
What The EMT and Para do not comprehend is the complexity and range of nursing.
LTC is a very different focus than emergency or even acute care.
Emergency care is based on algarythms. EMTs and paras memorize these because basically they do not deviate from them.
Acute nurse (even much more than emergency nurses) use critical thinking more and use them when applying algarythms. The nurses education is more extensive and complete than the para.
The para has ONE very narrow focus in thier entire education, emergency care.
Your education is much broader and more involved.
In emergencies they are the expert.
However. to dis a LTC nurse because her emergency skills are not up to par of some one who works only in emergency is like diss'ing an obstetrition because he cannot do heart surgery.
Thier ignorance stems from the fact that they do not know what they do not know. They are contstantly required to act in emergency conditions and have had to memorize protochols so that they are automatic without thinking. and working in emergency give these folks a false sense of being some kind of superior care giver because "they save lives".
All they really do is keep a situation as controlled as possible UNTIL the real care and life saving can take place.
Often they are adrenaline junkies, with a hero complex. Sorry, but I have had the misfortune of sitting in a firehouse listening to these self proclaimed heros tell the same story over and over such as about how they put in an IV on the fly (an event that took place over 2 years privious) To them that is a major big deal, worth repeating to every one who had an ear.
They do a lot of talking and patting self on back.
So how can they possible respect someone who has the job of a mere mortal and does not deal with life and death emergency every day.
I think much of the critcism about transporting DRNs etc it the funding. Unless they do certain procedures during trasport they do not receive funding for that run.
We have mostly volunteer emergency response here. However, there are several medical transport companines that are not emergency but do provide medical transport for patients. maybe this is who we should be calling. However they are not available on a moment's notice.
Hmmm....you have a very interesting perspective about ems. Sure there are a few Bubbas out there in the local firehouses that think that a non-rebreathing mask and rapid transport are the only treatments that a pt with COPD exacerbation or pulmonay edema secondary to CHF require.
But, as a paramedic student, I was exposed to nearly ever department in the hospital. In all 500 clinical hours minimum were required to complete the program. I rotated through pathology, lab, or, l and d, er, icu, ccu, pediatric icu, lifeflight, etc... And by saying that paramedics are not required to think proves to me that you don't know the definition of critical thinking.
I was taught that protocols are guidelines and that one must use.....critical thinking to decide whether the patient in question will benefit from the treatment guidelines.
You display many fallacies of thinking by generalizing paramedics into one category: That we are brainless trained monkeys that have been handed an ET tube and cardiac drugs. Many of my family members are nurses including my mother, whom I have a lot of respect for. I also plan to complete my nursing degree through EC.
We aren't just adrenaline junkies. I have spent many hours talking suicidal people into going to the hospital for treatment, delivered babies, fixed grandma milk and cookies after taking her to the hospital for N/V, assisted nurses and techs with code browns (nope, I don't think I'm above treating someone like a human being) and talked to elderly women and men at 2:30 AM, who called an ambulance because she was lonely and having a panic attack.
But I have also pulled mangled bodies out of cars, told sons and daughters that mom can't be saved, told mom and dad that their daughter couldn't be saved, as just a typical day in ems. Oh and by the way, as I'm sure you know, rapid sequence intubation is a skill that carries immense responsibility and liability, and many paramedics carry that skill and use it on a regular basis.
I pray that my words will somehow change your "critical thinking" skills, about paramedics. The next time you sit through a pals, acls, phtls, btls, nals etc....beware....many of your instructors will probably be paramedics.(many will be future physicians as well)
I was taught that the correct is algorithim. Maybe there is more than one spelling.
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from RNPATLOver the years I have also had several "encounters" with EMS personnel. They are consistently rude to the patient, family and the nurse. I am not sure why they have the sense of superority over nurses, but it has caused the death of several patients I know. I had one incident where I was working an agency shift at a nursing home. I am mainly an acute care nurse, but needed the extra money. Patient fell and smashed his head really bad. Initial assessment showed some minor neuro changes and I felt it best to send him to the hospital for further evaluation. He was a DNR. However, from my perspective, DNR or not, he fell and needed to be seen by a physician. When EMS arrived to the facility, I was giving them report and they took a brief look at the patient and said that he was fine and they would not be transporting him. I told them that if I had to carry the patient on my back, he was going to the hospital. The EMT and the paramedic laughed as if this situation was a joke. By this point, the patient had some significant neuro changes and I was concerned that he had a subdural hematoma and was continuing to bleed. I actualy had to call the supervisor for the Paramedic to get them to transport the patient. Unfortunately, the patient did die at the hospital several hours later, but how horrible that EMS personnel feel like they can play God, just because the patient has a DNR order. I am sorry .... but nurses are better educated and in many cases have a more comprehensive understanding of the patient. EMS just sees a glimpse of what we see and should learn to rely on our assessment of the patient.
UGH....here we go again. Not all paramedics and emts are this way. Please don't generalize us like that. Yes we have our share of jerks, but most of us aren't this way. I can assure you.
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from earle58one time i had the pleasure of an encounter w/an emt whose arrogance, disrespect and total disruptiveness on my floor resulted in my commanding his professionalism and to just do his damn job. the smart *** he thought he was, he turned around and reported me for "delay of treatment" w/my very sick pt. i proved this jerk wrong; his buddies would not stick up for him (they're not all bad) and i have a formal letter of apology from his boss with assurance that he was fired. i would have to say that 85% of my encounters are pretty negative. i don't know how long their training is but basic courteousy should be incorporated into their curriculum.
Where I live it is now an associate degree program. So yes...we are educated. EMT curriculum is roughly three semesters.
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from ceceliajane20036 weeks?????.....where can one get paramedic training in 6 weeks?....where i live, you can't get an emt education in 6 weeks. i don't know where you live, but you are wrong if you think that paramedics go to school for 6 weeks. try 18 mos minimum.[nurses less edu. than emt or paramedics4navy
dont be discouraged of some you think emt--paramedics more educated. they're trained in a 6wk--3month course for emergent episodes, to carry the patient to the next highest level of care.nurses and doctors, surgeons ans specialists. haaaaaahahhahahahahahaaaaaaaahaaaa----thats a good one. but, we're all in a tight knit circle together, we need each part. truly---take care, good luck in whatever venue you work
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from hogan4736I do walk in their shoes, and ALWAYS give a thorough report to the paramedic (we rarely use 911, instead we call an ambo company, unless, of course, a CVA is evolving right in front of us).
I also send ALL H&Ps, MARs, TARs, Vital signs, face sheet, Advanced directive copies, then call a phone patch to the ED charge nurse.
Now, I am the house charge, and don't have a patient assignment (aside from IVs), so it's easy for me to do this...BUT, night shift is the ONLY time the house charge has a med cart, but rarely has any scheduled meds, so she has plenty of time...
You sound like an awesome nurse. I find all patients fascinating as a paramedic. Whether it be a pneumothorax secondary to a chest to steering wheel collision, right down to replacement of a foley catheter. Something can be learned from every call. And a nurse such as yourself, makes a paramedics job much easier (as I'm sure you know). Getting a good report, necessary paperwork, and knowing the answers to questions makes patient care sooo much more effective. But I DO understand why an LTC nurse doesn't immediately know all the meds and allergies. With that many patients, it is impossible.
Thank you for being a good nurse
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from michelle126Good work Michelle....it sounds like you were having the shift from hell.Happened to me a few weeks ago... I had a few bad situations all at once....First one a resident fell in bathroom (of course blood everywhere), looked like a hip fx and laceration on shoulder also c/o sob and chest pain....down the other hall at the same time 2nd resident with BS below 40 and unresponsive. Meanwhile my two favorite alz pts were at the doors trying to escape (2 of them at different doors). It was a mess, call bells ringing, door alarms ringing and it was the 11-7 shift with only me (RN) and 2 CNAs and 50 residents. (Mind you I'm 39 weeks pregnant and as big as the side of a house!) Needless to say 911 was called for both (full codes). I was unable to "meet" each crew and give them a full indepth history, but they got the rundown... (lucky I had my cell phone that night) paperwork was a little sloppy (ended up faxing it to the hosp). The EMTs and paramedics that responded that night were ANGELS (Probably worried I'd pop my baby out right there!)
Just a little look into what can happen in a LTC with "appropriate" staffing, when things go wrong.
Thank you for all you do for humanity.
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from TuttiMany of the nurses at an assisted living facility I used to work at have had bad reports about the EMT's when they arrive. Sometimes the nurses don't know the meds these Pts. take because they self admimister. It's their home. So when the nurse responds to an emergency in someone's apartment, she responds as if she is finding someone in their own home.
On a personal note, when I was called to my 7yr old's school because she was dizzy and falling down and was unsafe to put her on the bus, I came to find her verbally unreponsive, sitting on the floor, falling over every which way, couldn't hold her head up, abnormal movements. Very scary. When the EMT's arrived (15 min. later), as soon as they heard my baby had a mental illness, they said, oh, well that's a behavioral thing, there's nothing we can do about that. Excuse, me, someone with a mental illness can't be sick, or as in her case toxic from her medication, which I informed them she had an increase of dose and had not eaten in 2 days. I could not drive her safely in her condition. At least the ambulance gave us a ride home, so I could observe her while I decided what I wanted to do. What a nightmare!
Yes, to expect a nurse in LTC to know all the patients medications is just plain ignorance. I will agree with an earlier post that education about the protocols for resident transports , for ems would be beneficial.
Jan 15, '05Joined: Jan '05; Posts: 17; Likes: 2Quote from Medic946RNI think my greatest tension between myself when practicing as a paramedic and the LTC nursing staff was that in 25 yrs of EMS I can count on one hand the number of times I have been met in the pt's room by the pt's nurse and given a decent report. The vast majority of the time I have been waved past the nurses station or had a room number shouted out me, only to find two, or even three elderly people with what I would diagnose as altered mental status. I always have to send my partner back out to the nurses station to find the nurse, then they send one down who gives the old song and dance about "this isn't my patient, I don't usually work on this floor, wing etc" "Why are you asking me all these questions?" You know stuff like, hx allergies, meds, baseline mental status. They never have the paperwork ready for you. The pt has been suffering with this condition for hours while they tried to contact the MD, but no one has had the foresight to copy his chart. Then they seal it in an envelope and tell you not to open it, only the Hospital can have that info. They entire time they're shooshing you out the door like a flock of recalcitrant chickens. And don't even start me on the times I've had to do simple things like suction a patient, or give a diabetic with a BS of 26 (which they hadn't caught) an amp of D50 while they stood around, clucked their tongues and tapped their shoes because " I was playing doctor"
It always seemed that instead being part of the continuum of care for this pt that me and my crew and even the pt were a major inconvenience for them. I've taken pt's out of LTC's in three states and it never varies.
HAHA...if youre like me I ALWAYS open the envelope. Someone would be wasting their breath to tell me not to open it. I have a responsibility to the receiving facility to give them a heads up about what is going on with the patient. It is what is expected of us.
Jan 15, '05Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415CAN WE SAY LONG...LOL! But excellent info
I find almost all the paramedics and EMT's I know personally have as much education and training as I do, just in a different scope of the practice is all. Where I am considered LTC RN, I have only been treated rudely a few times, and proably more because I am taking things personally than anything! I treat them like they are part of my patients team..and I feel that is the way it should go, even if I have to force myself into the picture from time to time to get listened to!
Since I am married to a paramedic, I get a bit of a more open responce from those that know me in our para/ems (and a ton of info about what they do, what is going to go on, and how I can assist!)! When I have time, and I am quick to start with...I get all my patients MAR's, Face sheets, POLST's, and any new info photocopied and ready for them as they are coming in (which sometimes is 2 mins! I am very lucky to have a post 6 blocks away!).
I scan over their charts to see what has been added since I was gone (I am in assisted living...160 patients, not like I know every detail when I work part time..LOL!), and give them a quick report of the situation as I am walking them in (or in cases of CPR, report is either delayed or on the fly with what info I know). I find that if you can at least help with getting medication lists together and a DNR/POLST it really helps!
When a nurse gives a paramedic/emt a report or a situation, it is considered transfer of care (and vice versa!)...so basically at that point I have given my consent to those paramedics/emts to do their job...something Nurses tend to forget. It doesn't mean you no longer can help or advise (and I strongly suggest keeping things to just info, not advise about what they should be doing!!!), but you have handed over care to them because...heck, you called them in the first place showing you need their expertise so that one is a no brainer, so it is their patient at this point...just stand by info/assist is the best thing you can do.
Things that help
1. Make sure you have all medications and treatments copied or known to tell them.
2. If there is a DNR, get the ORIGINAL...they must see the ORIGINAL, but some states say that after they see that, they can take a copy with them...but they have to actually see that original!
3. Move out large obstructions from a gurney path..take in mind large kits too! Only do this if it doesn't harm, or even move certain patients.
4. Do not allow patients to drink/eat or even go to the bathroom, at this point they are an emergency patient so basically a lay down and wait deal so they don't get harmed or complicate matters once they are in the ED!
5. Be to the point, they don't need info on how nice a patient is, maybe if they are combative, or have any behavioral/memory probelms..but not general chit chat! I go age, sex, general history, current complain/situation, and when it started...then up for questions with chart in hand (and my caregivers since they know the patient best!).
6. No time for rubber necking...be there for info, but stay out of the way basically and let them do their tasks/assessments. This is especially important for family that may be in the room. Get them into another room and talking about what hospital the patient may want to go (other info the paramedics/emts will need), or other conversation to keep them from getting in the way of them performing their tasks and assessments!
7. When a paramedic is asking questions OF THE PATIENT, please look at the paramedic and see if they are talking to you or not! Just because they are asking a question you know the answer too, or have already asked, doesn't mean they want it from you...it is an assessment tool for them (and us too guys!)...so let the patient answer! If the questions needs answering they will ask you..trust me!
8. Something hard to remember sometimes..but do ask the paramedics/emt's where they may be taking the patient! That helps when you notify MD's and Family! Sometimes hospitals are on divert, so that hospital you assume they are going to may not be available, so another must be chosen..or the paramedics may take them to a hospital more equipt to handle the case. Just something I learned by not asking..LOL!
9. They are professionals too, please give them credit for what they do by being professional and poliet.
10. And this one is for those with DNR's and POLSTS in hand, Paramedics/EMTs know what they are doing when it comes to DNR's/POLSTS better than nurses do, so don't get all touchy if you all the sudden see them put in an IV when it says no IV's! Most states have a grey area for 'short term' IV use, which is under 3 days...so the expertise of the paramedic can make the choice there! A hospiatal ER Physician can order it pulled if need be, must most times it is really needed for various things you may not have considered. I have had more nurses complicate matters over this..and even fire EMT's towards Paramedic...they know what they are doing so if you really feel the need, state your point and leave it alone! Best they do it then and there then having to cater to a Nurse or Family member and have to do it in a bouncing ambulance...trust me! (oh that is a real treat! Nothing like hitting a speed bump/sudden break in mid poke! LOL!).
OH yeah..and I rather liked my hubby's teaching about what it means to be a paramedic/emt to his student riders! "When is the ONLY time this patient will have 100% attention for 100% of the time by one medic? Yep, in our ambulance! So keep your eyes open for everything going on with this patient! What may be the chief complaint may be just the start, so best we get this information and relay it to the ED staff so the patient gets the best of care! Here we are, 1 foot away from this person for 15-30 minutes with our eyes only on them...and it will be the only time this will occur and a great time to learn and assess as much as we can! Even the nurses in ICU or CCU have more than one patient to have to watch...us..THIS ONE! Our info will help other medics to help this patient...keep those eyes and mind keen!"
I thought that was pretty cool!!!!!! Very positive and right advice!!!!!