tension between EMT and LTC nurses?

BBFRN, BSN, PhD · Mar 21, 2004

Lol...ya like my flame-retardant chicken suit?

flowerchild · Mar 21, 2004

I can honestly say that in my years of nursing, NO ONE has treated me with less respect than the EMT's. In HHC, LTC, and in my current clinic environment! Nor in my personal experience, as 2 EMT's came to my home in answer to my EMS call d/t my husband having an MI, asked me what kind of nurse I was, rolled their eyes and proceded to do everything in thier power to disprove my diagnosis. I was right, thier ineptness and grandious attitude was the number one contributing factor to my husband losing 30% of his heart muscle d/t lack of treatment. Problem was, they followed him into the ER and did the care at the ER too! It took me SIX HOURS before someone finally believed me and started his treatment.

I have more stories too, like the HHC COPD patient gone bad, I called, got the attidtude, as usual, they took him only on my insistance, patient died within 24 hours.

Or how bout the kid in my clinic with a BS of 17, they stuck thier head in the door, from 5 feet away, took one look at the kid, and said, you have it under control, he is fine, and WALKED out on me!!! Mind you, I'm in a clinic all alone. No back up, no emergency equipment or medication. EMS is my ONLY backup.

I reported those cases to the head of the dept. They were reprimanded. After my hubby, an entire cardiac program was revised for EMS. I am currently on a first name basis with the dirctor of our large county EMS program, I am continually asking him to help improve the knowledge of EMT's about Nurses and our function. Over the years since I started this fight, in 1995, things have gotten better, but it is a continious fight for respect.

And, yes I agree, the classes that the EMT's took, both prereq and req's are not on the level of the nurses. The nursing requirements are much stricter and of higher levels. PERIOD.

I can only sumise that saving lives and picking up people off the pavement, skews the EMT's perception as to who they are.

OK, EMT's flame me at will but what i have said is the truth of the matter.

flowerchild · Mar 21, 2004

Lol...ya like my flame-retardant chicken suit?

Can I borrow your suit???

Coldfoot · Mar 21, 2004

Ahh, the age old dispute, "EMS types don't have the education to tie their shoes but nurses are a bunch of overpaid bed changers!" LOL

As someone with several years in both prehospital EMS as well as several years as an ER Tech (and now a nursing student) I've seen the attitude (and I'll admit had the attitude at times) that we're talking about here.

One point we need to keep in perspective is that people don't remember or post about the good things. I remember the calls and the nurses involved to LTC's for the IM D50, the CPR in progress in bed :uhoh21:, the status seizure that hadn't been checked on since EMS was call non-emergent 30 minutes ago, the hysterical "Push Bicarb! You have to push Bicarb!" arrest, the CHF secondary to an unattended IV or the IV start after 12 attempts by the facility because the patient had been double dose on lasix just prior to having the IV D/C'd.

I know I ran a lot of calls with helpful, competent, pleasant, caring, knowledgeable, respectful, conscientious nurses that had all the paperwork ready, had informed the patient they were going to be transported, had called report to the receiving facility, were happy to give me report and were pleasant to work along side of. These are not the people that get posted about on the WWW (yes it's wrong, but it's really human nature).

Like Cotjockey said, your residents deserve the best care anyone can deliver. There is certain information available at the LTC that will significantly improve the care your patient receives, pleases share that with EMS.

As far as the comments about EMS personnel being upset about responding to a LTC instead of a trauma, 90% of the paramedic you'll run into outgrew that a long time ago.

I currently work for a Critical Care Medevac Team and our crews are composed of a Nurse and Paramedic. They are this way because the knowledge bases compliment each other.

Long rant but like I said this is the age old debate and we all (nurses and EMS personnel) need to get over it

Can't we all just get along? :chuckle

RNPATL, DNP, RN · Mar 21, 2004

Over 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.

leslie :-D · Mar 21, 2004

one 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 ass 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.

Betty_SPN_KS, LPN · Mar 21, 2004

I'm just a practical nursing student, so I don't have as much knowledge base yet, but I hope to learn much more of what you all are talking about.

My cousin is a paramedic. (He also wanted to go to nursing school and learn both). He was sharing with me several years ago about the conflicts between ems and nurses not understanding each other and why they do as they do. Nurses learn some stuff about a lot of different things. Paramedics learn a lot about a few things.

Paramedic school and ADN RN programs are both 2 years here, but each with their own content. EMT courses are much shorter, of course (9 weeks maybe?). Less education, less professionalism, more "attitude"? Of course, this is very individual and not all people with less education would have the worst attitudes. (I hope not, I'm one of those with less education).

Also, I have a classmate who is a paramedic. He has been very helpful to me as a fellow student because of his knowledge and experience.

flashpoint · Mar 21, 2004

The biggest problems I've encountered are the ones I mentioned in my previous post. I've also been asked to wait to transport so the CNA can finish shaving the patient (he was BLUE...we didn't wait), I've been directed to a room by a housekeeper and found no nursing personnel anywhere and had to trasport the patient with no information except our assessment. I've had nurses rip the transport packet out of my hands and tell me that the information was for the HOSPITAL, not a bunch of firefighters and I've had nurses scream at me for giving oxygen to COPD patients. I've also been asked to move my ambulance to the back of the facility and bring my cot in through the kitchen (after everyone on the crew dons a hairnet) so that the ambulance in front of the facility doesn't attract attention...the patient was coding in the lobby by the front entrance. Most of my experiences between the ambulance service and the LTCs are positive, but the negative ones sure stand out...it does not, however cause me to lump all LTCs and their nurses into one big negative lump. But...I think that everyone should remember that we all have our places in health care. As a paramedic, I would never think I was qualified to care for my elderly parents as well as an LTC nurse could...neither should she presume to be more qualified than a paramedic when things go belly up. We are trained to treat and stabilize until definitive are can be provided and that is what we do...LTC nurses are trained to provide long term care and that is what they do...both needed and both very different.

Betty_SPN_KS, LPN · Mar 21, 2004

The biggest problems I've encountered are the ones I mentioned in my previous post. I've also been asked to wait to transport so the CNA can finish shaving the patient (he was BLUE...we didn't wait),
I suspect he hadn't been shaved in a while and they were trying to cover their backs? They didn't want to appear to be neglecting their patient? Of course, delaying emergency care for this was much worse neglect.

flashpoint · Mar 21, 2004

I don't really think it was neglect...the LTC is known for good care, I just think that priorities were overlooked. I think the nurse tunneled in on the fact that the resident wan't shaved because maintain appearance and dignity is important to her. We tunneled in on his cyanosis because we see people at their worst...no one takes a shower and does their hair before calling 911.

Blackcat99 · Mar 21, 2004

:chuckle Thanks everyone for your great real-life stories. I have worked as a CNA and an LPN in LTC. If you really want to know what's going on with a patient ask the CNA. A good CNA spends much more time with their patients than the nurses. Unfortunately, most nurses in LTC have 40 plus patients and are unable to spend much time with any patient. If I'm not passing meds,doing treatments or filling out yet another incident report on a patient falling I'm usually on the phone with pharmacy trying to figure out why certain meds -usually narcotics and antibiotics never arrived. If I was EMS I would be asking the CNA what they have observed.

smk1, LPN · Mar 22, 2004

I saw the thread the OP is talking about on SDN, and I didn't feel the EMS posters were being disrespectful. They had some legitimate complaints, actually. I think I would feel the same way if I were them. (Don't flame me, please).:chair:

there are several posts in the prehospital forum but in a few of them there are long tangents taken regarding incompetent nurses and how uneducated they were, this is what i was surprised at and the fact that very few if any put in a good word for nurses. and some were VERY disrespectful, making jokes etc...