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?
I just think it's time to drop the subject of the OP's harsh opening post and concentrate on the underlying legitimate complaint. He never stated that he wanted to become a counselor, why continue to ridicule his communication deficiencies? I thought this thread had moved beyond that to more contructive dialogue.
Funny you mentioned this because I was going to myself.
FRIENDLY MODERATOR NOTE
I've been letting this discussion go, but I agree, it's time to stop flaming and putting down the original poster. It's been done for 8 pages and the op has gotten the message.
Please lets not talk about the op back and forth to one another either.
Stick with the issues, or move on from this thread, it's getting old.
Thanks so much.
Further flames to the op or each other will be deleted.
I was the only med-surg nurse in ACLS recently, the rest were ER and ICU nurses. The educator was part of the new rapid response team, who said "the reason we're starting the rapid response team is to help the med-surg nurse because they don't have good assessment skills and they are uncomfortable talking to doctors............"
No. lie. My jaw just dropped, but that's a battle I didn't choose that day.
Wow, that is harsh, and so demeaning, and downright not true. I had a patient a few weeks ago (I am in a cardiac/neuro unit) anyhoo...this patient was on peritoneal dialysis, and had an order for the night cycler. I can catch an early stroke, read a cardiac strip, but I have never even SEEN a night cycler machine, let alone know how to use one. Guess what? I called a nurse from MED-SURG to come educate me. This rn was so good, she knew everythign about PD and the cycler. We all have our specialties, all units have emergent situations. I know there are incompetent people in all fields. I will also say, I have spoken to the MD's at 3am who want to do nothing when my patient goes into afib w/rvr, or my A&Ox3 pt suddenly cannot talk me, and the MD says "I'll see them in the morning." Talk about incompetence. Hey, I see incompetence at Walmart. We all as professionals need to take it upon ourselves to be the best we can be at whatever aspect of healthcare we choose to work in. If we know we don't know something...ASK!!! Seek education, sign up for CE hours, attend seminars offered by your institutions.
Phew....thanks for letting get on my soapbox.....I,m stepping off now...
Heck I read that topic as Impotent nurses!:trout::trout::trout::trout: LOL
At my last physical, my MD asked whether I'd been having any ED problems. Fortunately, I haven't had to be a patient in our Emergency Dept. for some time, but after giving the matter some thought, I had to admit that the report they give usually sucks.
medicrnguy, i am a nurse living with a cardiac arrhythnia, and believe me, i'd rather you be my nurse any day over someone less competent. i see you have got alot of snobbish remarks, trust me they are just jealous and too lazy to get the education that would qualify for the position, they are currently working. hats off to you.
side note, be more aggressive, save patients, if they cant hang, thats they're orifices.
i love nurses like you!!!!!!!!
kepp doing what you do. hugs!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:yelclap::redbeathe
All in all, i'm an optimist. Egos shouldn't get in the way of patient care. An understatement of the year.
My brother is a paramedic. He tested for his license the same week I tested for my RN. We both busted our butts through school and have always appreciated eachother's career route.
One of our favorite things is to get together and talk about our experience. We both learn from eachother.
He has listened to me vent about incompetent nurses, just like I have heard him blast his coworkers....
Education doesn't stop after we get that shiny license!!! If I am uncomfortable with something, I ask, take a class on it, and buy the book... my brother does the same. Some people are just in these professions for the adrenaline rush or the money... and those are the ones I am terrified of b/c they don't give a *(
I'm sorry for the dissapointments you have encountered, but try and change it and not just feed into the complaints.
Telemetry comes in many flavors. My first job as a nurse was telemetry. They hire 5-8 or more new grads a year (in a unit that has about 60 total nurses counting all shifts), send 'em through a basic arrythmia class, one day of "cardiac" classes, the regular new grad classes, and 3 months of orientation with a preceptor.
The result? We got really tired of being bugged by the tele people on the phone all the time... "leads off here, battery there, low HR somewhere else..." It's frustrating when you're just learning to read your own rythyms, and barely handle 4-5 patients, without having people call you and tell ya what to do at random. Well, anyhow, that's what it felt like. I started out calling for my readings, and comparing them to what I saw. It took at least 6 months for me to feel like I could actually read it myself, and then I'd call if I saw something funky but not emergent, just to get a second opinion.
Then there were the times I called to find out how many beats that run of VT was, since they can pull it up faster, to have the tech say "huh?"
Nobody's perfect. But we're all on the same side. Funny story: once an ICU nurse with the rapid response beeper sauntered through the tele room, stopped, picked up the phone to call the nursing supervisor, told him to get to room XXXX, because they were bradycardic almost in asystole, and no one had beeped him to let him know. When the sup arrived about a minute or so later, he found the nurse for the patient had him on the external pacer, the cardizem drip that had been started in ER was off and disconnected, and the patient was starting to have capture from the pacer and starting to pink up a bit. Her response? "What would I call the assessment team for, I know what's happening, didn't have time to pick up the phone!" Code avoided.
My job now involves monitoring for the med-surg unit from my small ICU, which can be interesting when I've got stuff going on in there as well. And yes it can feel like I'm talking to a brick wall sometimes. They do think I'm a bit nuts when I make predictive statements about their patients' possible conditions based on a rythym, but it's actually based on the rythym, the change, and experience. I have to step back and remember that they're overworked out there. I know it's not fun when all your patients are keeping you busy and the ICU nurse bugs the crap outta you about your only sleeping patient... who just happens to keep having episodes of complete heart block. Just think, the night will get a whole lot worse if you have a code.
From the monitor end, it helps to make nice, explain yourself, talk to the charge nurse, and use the house supervisor if you think nothing's being done or that what is done is inappropriate. From the nurse's end, it's really hard to work a tele unit when you're new, or when you're understaffed, or when a whole bunch of stuff goes wrong at once. You know, when you call a nurse about a conduction change, she may have just gotten out of the room of the cranky ole fart who cussed her out up one side and down the other for not allowing him to take all the nitroglycerin pills he wants to as a sleep med. Or maybe she did call the doc about the 2nd degree type two, that keeps slipping into complete in the 20's, and he just told her to call a code when the patient's heart quit beating, so now she's got the code cart in the hallway outside that patient's door all night.
It's not just the nurses, it's the whole shebang sometimes.
It is a reality that some nurses are incompetent, but it's not also proper to judged them as if they only know superiority over their subordinates. If you have concerns like these, why not brought them to proper authorities like the nurse supervisor or chief nurse? You claimed to be an RN yourself, your school must have taught you proper incident reporting. Do you still remember Professional Ethics? :angryfire
Does your facility have a Nursing Supervisor to notify if the floor RN's do not resolve the arrhythmia issues with patients? Most Facilities have a Nursing Supervisor for these types of Issues. If your facility does not then I would be looking for another place to work.
The NCLEX is definitely not a quiz!!!
If LPN's are the better Nurses then how come you became a RN instead of an LPN? PLEASE!!!
I have a confession to make. I am an RN. I care for patients on telemetry. I am terrible at cardiac and telemetry. HOWEVER, when the phone rings and they tell me about a rhythm change and I do not know what they are talking about - I just say, "OK, what does that mean." I'm not afraid to look stupid. I just ask. Heck, everyday there's some new surprise on the job when one of us says "What's that mean." Isn't that how it works? I certainly wouldn't ignore it. I can say if one of our nurses did ignore it and it was bad enough an ICU nurse (our telemetries are montiored in ICU) would be standing on our floor or at the patient's bedside shortly. I have seen them try to call us, get no answer and out of concern come to the bedside - to find us at the bedside where utilizing our med-surg skills we had already realized there was a problem. At which time we welcome the extra brain to the problem solving.
Don't be too insulting. I orient new nurses. On occassion I find one who knows a lot. One who knows more than I do about something. I don't get insulted. However, if the new nurse thinks they know more than I do about everything they will quickly hang themselves. There's a lot of variety in my med-surg world and you're going to need this RN eventually. Of course, I'll be sure the patient is cared for, but I won't necessarily care about your ego in the process.
Be careful. We can't all know it all and neither do you. I do agree the nurses shouldn't ignore the calls, but that is for managemant to deal with. You can't fix them, just report it up the chain of command. If your concience isn't satisfied, find another job.
Hi I usually just enjoy reading things that others print, but when I read about this one I felt compelled to reply. I have been an LPN for 12 yrs. and now I am currently in a bridge college program to get my RN degree, I have the pleasure to sit by a paramedic in class. And I also study with several paramedics within the class. We all have already discussed with maturity our strengths and deficets within the two fields. We rely on each other to share our strengths. I think we have agreed that wouldn't it be wonderful to diffuse our knowledge together and be one smart cookie. I agree that paramedics must go way more into detail in their studies when it comes to cardiac including the meds., and they are up on the latest emergency drugs and emergency task that save a lot of people's lifes. But what they are having to learn is the disease process & the interventions to do to prevent or assist a pt. with a dx. They usually see the end results of a dx. or an acute mess of a dx process. But I think we have a lot we can learn from each other.
Tweety, BSN, RN
36,337 Posts
Funny you mentioned this because I was going to myself.
FRIENDLY MODERATOR NOTE
I've been letting this discussion go, but I agree, it's time to stop flaming and putting down the original poster. It's been done for 8 pages and the op has gotten the message.
Please lets not talk about the op back and forth to one another either.
Stick with the issues, or move on from this thread, it's getting old.
Thanks so much.
Further flames to the op or each other will be deleted.