I didn't know whether to list this as vent or concern, so I guess I'll just let it all out. I have been an RN for about 3 years and was a street medic for 7 years before that. I feel like I might be opening Pandora's box of the paramedic vs. RN discussion that has no easy black and white answer or solution to mutual respect one for another. My concern is the level of incompetence of nurses. Let me give you a few examples, but first some background information of the facility I work for. We have a centralized cardiac telemetry service that monitors the rhythms of all the patients on telemetry on the 3 cardiac units and 3 medsurg floors. It is staffed by either LICENSED paramedics (in my state we are licensed) or by extremely qualified personnel that have had extensive cardiac rhythm education. There is one unit that has a very big ego when it comes to the superiority of RN's and despite the outcome to the patient, refuse to listen to the advisement of a patient's rhythm or change. Every unit in our hospital of 400+ beds has emergency phones located through out every floor for tele services to use in cases of lethal arrhythmias. (examples: v-fib, v-tach, brady 140). Now for the examples of incompetence
1) A patient had an A-V nodal ablation and was totally pacemaker dependant. Shortly after arriving from the EP lab the patient goes in to a slow wide complex tach (WCT) in the 120's sustained. The cardiac floor was notified of the rhythm change via the emergency phones. The nurse and charge nurse ignored the advisement of tele services. The floor was then notified every hour on the hour for about 8 hours (we work 12 hour shifts) of the WCT. The nurse did not notify the EP doc. The patient then codes right at shift change. They coded the patient for about 2 hours and ultimately the patient died. The family files a law suit. EP doc was very livid at the withholding of information from him by the nursing unit (Tele services cannot contact a doctor themselves.)
2) Same cardiac unit different patient and different nurse. Patient was on a lido drip for ventricular ectopy. (big. And trig. PVCs, slavos, short bursts of WCT. ) The patient goes into 2 degree AV block type II (AKA Mobitz II). Again tele services used emergency phones to contact the nursing staff. Again nursing staff does not appreciate the notification of the rhythm change. A follow up call was made to the floor. The experienced charge nurse turns up the lido drip in response to the new arrhythmia. (It is an arrhythmic, but come on people- check your nurse drug guide you had to purchase in nursing school!) Fortunately the tele services employee convinced the charge nurse to contact the doctor. That probably saved that particular patients life.
3) Different patient same cardiac unit. The patient is less than 24 hours post cardiac intervention. The patient goes into v-tach. Again the emergency phone was used to notify the floor. When the patient comes out of v-tach after 55 beats, they are having tombstones. Follow up call was made to nursing unit. Of course the nurse checked the patient. They were snoring (it was at night if you want to give them the benefit of the doubt). So the door was shut and the nurse went back to the satellite nursing station. When advised of the tombstones, patient was found basically dead. The patient was coded but was never resuscitated.
Now my concerns: I have been through both paramedic school and nursing school I know that there are some differences in the ways paramedics treat and nurses are suppose to treat patients. Our cardiac rhythm training in nursing school was very, very, did I say very limited compared to what I went through in paramedic school. Sure in nursing school we are taught the basic principles of common rhythms like SR, V-Tach, V-fib, A-fib/A-flutter, ect. But what about MAT, A tach, PMT, non-conducted PACs, 12 lead interpretation (I do not mean the doc-in-the-box interpretation included at the top of the printed EKG), Juntional Tach, in depth training on A-V blocks. My education as a paramedic was superior in this aspect. One can argue what about lab values, checking for dilation on an OB patient, acid base balance, antibiotics, microbiology, yada yada yada. Thanks for asking. How many nurses actually get to check for cervix dilation other than those that birth babies- how many can remember what a 7 feels like compared to a 10? Lab values- at our facility reference values are printed on the same sheet that the results are printed. Microbiology? Well truthfully I don't remember much from that required prerequisite to nursing school, so I guess I never had much use for it. An intelligent monkey can be taught to hang antibiotics with the use of an IV pump. So I don't think of paramedic school as training. It is education. As a matter of fact, our medical director of my paramedic school actually went through our curriculum and stated "This is the 3rd year of medical school". How many physicians have said that regarding the "education" of nurses? Really if this has happened I would like to hear about it. And this is just my personal experience, but I have met more incompetent experienced RN's than incompetent new grad paramedics. I have been through both. The NREMT-P test is much more difficult than the NCLEX. NCLEX is more of a quiz.
And lastly, I would like to pay my solemn respect for ancillary staff that assist us RN's and making our job a complete circle of care. CNAs you have no idea how much I respect you. You know the patients. You are an invaluable set of eyes and ears to me. You see the slightest changes from baseline of a patient. I want to sincerely apologize for the other RN's that treat you as if all you know is how to wipe a butt, or empty a Foley catheter. Maybe one day when all the CNAs on your unit get blue flu, and the nurse must get out of the satellite nursing station and take their own vitals, and give all 7 of their patients a bath, they will have the same respect for you. (not to give anyone ideas.) To the unit clerks: I wish I possessed your knowledge on entering orders into the computer, or who to call when my patient needs a hepabilliary scan. Thank you for your job well done. To the cafeteria worker: what a blessing to see a smiling face when all has gone to hell, and I get a 10 minute break. To the supply clerk: I greatly appreciate you speediness when you get my X-large latex free gloves to my floor right after my c-diff patient has a BM the size of Texas. Nursing students: don't let these high minded individuals give you reason to become the same way. I understand that someday you may be hanging a lido drip on me or my family. Don't let these RN's give you any hell for asking questions to educate yourselves. Field medics: If I am in a car accident and the RN in the car behind me want to help, please have them block traffic. They are not in their controlled environment with a specific order written for a specific patient, so they probably don't know what they are doing. LPN's I believe you are the better nurses. Nothing heals like a caring touch- yes human contact- not an automated blood pressure cuff activated from the station. You have obtained a huge amount of knowledge. If I or any other RN's is doing something detrimental to a patient, stop them, don't put up with this higherarchy BS that they have taught themselves.
RN's get over yourselves! You are not God's gift to modern medicine! Without the full circle of staff, we could not provide patients with any type of continuum of care. (I do understand there are more like me, so this is not to include everybody. But those that needed the previous statement- you know who you are.)
I know there are some very appreciative, competent RN's out there. I'm sorry if I have offended you this was not my intention. I wanted to try to explain the whole circle of care from pre-hospital to discharge nurse. Are there any suggestions on how we can correct these problems?
