why do nurses hate medics?

[loboracer]

Not to offend anyone, but I have been in this game for over 12 yrs. I have worked with sone very good nurses but I have found that the majority of ER nurses are quite hateful to paramedics. It seems to be the younger nurses too. With the most current survey showing paramedics making an average of 14.xx per hr and nurses making 30.xx and hr... you would think it would be the medics with the problem. I am not talking about low educated medics either. In this area medics have ACLS, PALS, NALS, PHTLS, ABLS, proficient in 12 and 15 lead interpretation, etc.. We have medics that work in the ER not as techs but actually are assigned rooms as RNs. Can do everything as an RN except hang blood although you are trained in it. Medics have to choose the med they give in the field based on assessment not by dr. Order on the computer. Some opinions from nurses? I am not wanting a war here just enlightenment.

[GrannyRRT]

We have medics that work in the ER not as techs but actually are assigned rooms as RNs. Can do everything as an RN except hang blood although you are trained in it.

It might help if you did not say "as RNs" or "like an RN". You are not an RN. You do not have the same education, degree or credentialing. I have heard this since we allowed the ER Techs to do nebulizers in the ER and then it was "we're just like an RT". That of course ceased when RT took back the nebulizers.

Instead of always saying you are just like an RN or RT or a doctor, why not say you are a Paramedic with more skillsets or education? RT also overlaps with nurses in some skills such as IVs, meds and ECMO but we do not say we are RNs nor do the nurses say they are RTs when they intubate in the NICU or PICU.

Medics have to choose the med they give in the field based on assessment not by dr. Order on the computer

Your protocols are written orders. The orders for a nurse or RT on a computer are generally a formality to keep everyone on the same page and to be part of the permanent record. In the hospital you more than one person caring for each patient and more than one patient for each caregiver. Both RNs and RTs have protocols to initiate therapies from an assessment.

As medics we know what nurses are capable of, but they would never understand our role and how much schooling and rigorous testing medics go through.

I would say most medics do not know what nurses are capable of. A lot of nurses don'e know what they are capable of until they get a job with new things in their job description.

But an example of medics not knowing:

yes we do get to do a lot of different skills (some that even nurses cannot

This is a negative toward nurses. It is not that a nurse "cannot" but rather their job description for different positions don't call for that "skill". Nurses have a very, very broad scope of practive which includes central lines, arterial lines and intubation. Does every nurse need to perform these skills? No. But, that does not mean they "cannot" if their job description calls for it.

[PMFB-RN, RN]

True story.

A couple years ago, while on call for the trauma team I got report from local EMS who was en route from a local gun range. Per witnesses the patient had been reloading a muzzle loading rifle (think musket) and when he rammed the ball home the gun discharged and drove the ram rod and .50 caliber lead ball through his hand.

Patient arrived A&O and on a back board & wearing a C collar.

I asked the EMS guys:

Me: Did he fall?

EMS: No, the whole thing was witnessed by his brother who is here with him.

Me: Why is he on a back board and C collar?

EMS: (looking a little embarrressed) Well we don't get to use them much and Steve here needed the experience................

Top be fair these are not paramedics, but teachers and mechanics who volunteer as EMTs on a rural ambulance service

[ChicagoRN84]

When I was a medic, I brought in an unresponsive older man, breathing perfectly well with sats99% on RA. BP was in the tank, and no visible veins. Now, when I say no veins, I'm known for putting 18's in little old ladies and going for legs or anywhere else to get a line, and I will get lines in where no one can. Due to his decreased LOC, I Went straight for the IO to get his BP up, NSR on the monitor and went to the ER. BP improved, still unresponsive. The ER nurse started yelling at me for not intubating and for doing the IO. I informed her that he is breathing on his own, did not need to be tubed and then have to be in a vent for the rest of his life but needed fluids and needed that IO. She proceeded ignorantly to pull the IO in front of me, saying I should have done a periph, and to get out. An hour later I decided to check on him. He was circling the tank, the RN was dismissed from treating him, no line was still available and they were about to do a central line after many failed attempts. And I have many stories like this. Medics need some sort of an ego, because we don't have support staff, we don't diagnose, but have to in order to treat our pt's properly. We may have standing orders, but it's our critical thinking and years of learning that saves lives. We have more education than a quick semester at some local college.

But truly, we all have our own stories of how a medic or RN or anyone was rude. Let's put that aside and work as a team. Teamwork is what really helps our pts.

[PMFB-RN, RN]

It sounds like you are a flight nurse, or something similar... which is completely different than an ER nurse, which is what this discussion is regarding. I think it is pretty safe to say, and I am surprised if you don't already know this, that most nurses are not flight medics, and most nurses are not trained to intubate (any form). I understand that it is highly likely that there are ERs that train their nurses beyond what is typical, and I think that is great. However, I do not think it is the majority of nurses that are trained this way.

The title of the OP just said "nurses" I had no idea it was posted in the emergency nursing forum. I am not a flight nurse anymore. I am casual in a hospital based critical care transport and EMS service but becuase of my casual status, and my dislike of helicopters I only do ground ambulance. This used to be my full time jobs.

My main job is in hospital Rapid Response Team RN (RRT). Don't let the "team" fool you. When a rapid response is called the "team" that arrives is one RN. The skills I mentioned are RRT skills that we are privlaged to use in the hospital.

In any event I was responding to the part of Loboracer's post that said:

Medics have to choose the med they give in the field based on assessment not by dr. Order on the computer.

This is of course absurd since nurses regularly do the exact same thing, give medications based on their assessments using standing orders and protocols.

And:

Yes, we get to make decisions without a dr's order (instead we have many standing orders; however, we do get to make big calls every once in a while)

Of courses nurses do this daily in many RN rolls.

And:

yes we do get to do a lot of different skills (some that even nurses cannot),

I asked what skills those would be but nobody answered me. I am unaware of any skills that a medic can do that a RN can not be trained to do. Obviously our training is very different. Intubation for example. Nurses are not trained to do in nursing school, but a nurse CAN intubate, and many of them do. I live in a VERY rural area where is is common for regular ER RNs to be trained to intubate in tiny critical access hospitals. For example one hospital where I used to work often didn't have any patients overnight. In that case the entire night staff of the hospital consisted of 2 or 3 people, depending on if the provider (maybe a doc, or maybe an NP or PA) is in house, or taking ER call from their home down the street. So it's either one RN and a lab tech with the provider on call to come in, or a provider, one RN and a lab tech.

So I have personal experince with RN who regularly intubate in at least three rolls, rural ER, RRT, and transport. I am using intubation as an example to represent other skills.

Similary when I was in the army nurse corps officer RNs often did things that in the cilivian world would be strictly a physician skill or task.

And:

I have run into irritated nurses that don't understand why I may have done something... they work in an ER, with a roof and walls. There is no rain or snow falling on their heads, wind gushing at them, they are not in the back of a bumping and jiving ambulance while trying to treat their patients... they don't understand sometimes why we do this instead of that.

There are nurses who do work in that roll as well. I gave an example. True most nurses don't, but they can and do.

[loboracer]

As the original poster... I am also an EMS Supervisor. So it is not just me. I am glad to here that there are so many that do not feel this way or see this. I disagree with rhe person that says medics are trained in 2 areas. Where in the world do you live? I frequently transport to 4 different hospitals and my crews report it to me all the time. Yes there are bad medics but there are bad people too. Thanks for all of the replies.!

[NDXUFan]

I've worked with medics for nearly my entire career including 7 years in an ED. I have never witnessed or experienced what you have described. I have seen overworked nurses get a little crispy when an outside medic brings them their 5th squad patient in 20 minutes but it's not personal and I would just as likely see the same nurse give the same medic a huge hug after a rough run.

HUG those nurses :)

[ChicagoRN84]

And for skills, different areas = completely different allowances. In my area, nurses can't intubate, decompress, surgical or needle cric, IO. Can they learn? For the most part, of course they can, but it is not there scope in the hospital setting. It's just the different skill sets that are needed for our area. Pre hospital care has many liberties and autonomy where nurse do not, unless they are APNs, and that should not be part of this discussion.

[Lev, MSN, RN, NP]

When I was a medic, I brought in an unresponsive older man, breathing perfectly well with sats99% on RA. BP was in the tank, and no visible veins. Now, when I say no veins, I'm known for putting 18's in little old ladies and going for legs or anywhere else to get a line, and I will get lines in where no one can. Due to his decreased LOC, I Went straight for the IO to get his BP up, NSR on the monitor and went to the ER. BP improved, still unresponsive. The ER nurse started yelling at me for not intubating and for doing the IO. I informed her that he is breathing on his own, did not need to be tubed and then have to be in a vent for the rest of his life but needed fluids and needed that IO. She proceeded ignorantly to pull the IO in front of me, saying I should have done a periph, and to get out. An hour later I decided to check on him. He was circling the tank, the RN was dismissed from treating him, no line was still available and they were about to do a central line after many failed attempts. And I have many stories like this. Medics need some sort of an ego, because we don't have support staff, we don't diagnose, but have to in order to treat our pt's properly. We may have standing orders, but it's our critical thinking and years of learning that saves lives. We have more education than a quick semester at some local college.

But truly, we all have our own stories of how a medic or RN or anyone was rude. Let's put that aside and work as a team. Teamwork is what really helps our pts.

That RN was an idiot.

[PMFB-RN, RN]

And for skills, different areas = completely different allowances. In my area, nurses can't intubate, decompress, surgical or needle cric, IO. Can they learn? For the most part, of course they can, but it is not there scope in the hospital setting. It's just the different skill sets that are needed for our area. Pre hospital care has many liberties and autonomy where nurse do not, unless they are APNs, and that should not be part of this discussion.

No IO? Really?

Don't you have nurses working in pre hospital rolls in Chicago?

[ChicagoRN84]

Very few have pre hospital roles, but those practices they can do in the field they are unable to perform in the hospital without higher status

[GrannyRRT]

And for skills, different areas = completely different allowances. In my area, nurses can't intubate, decompress, surgical or needle cric, IO. Can they learn? For the most part, of course they can, but it is not there scope in the hospital setting. It's just the different skill sets that are needed for our area. Pre hospital care has many liberties and autonomy where nurse do not, unless they are APNs, and that should not be part of this discussion.

According to the State of IL, PHRNs can do everything a Paramedic can do plus that of an RN.

I do know transport nurses (and RTs) from that state who do practice those skills inside of a hospital regularly to maintain their SCT skills. They are not APNs. Our Code and Rapid Response RNs (RTs) also have an expanded set of skills and education with a lot of protocols.

But, if you want to go down that road, there are many states which will not allow Paramedics to perform RSI or transport a patient which had medications or equipment outside of their limited scope of practice. RNs (or RTs) must accompany the patient. There are also places which will not allow Paramedics to intubate a child. There are other places which have removed ETI totally and will only allow for a King airway. Some places still do not have IOs on their ambulances.

We have a list of medications and equipment which a Paramedic can transport. It is not a very long list and if it is not on the list, a nurse, RT or CCT with a nurse or RT must transport. Again, these are not APNs.

Some IFT Paramedics have not intubated or started an IV in all the years they held that position. Some EMS Paramedics rarely get an intubation during a year. The sad thing is some do not even have the opportunity to practice this skill. You might also list surgical or needle crics but if most Paramedics are honest, it has been a long time since they reviewed the procedure and most will never perform some of the advanced skills in the field. I doubt if any Paramedic would ever be allowed to do a cric or needle a chest in an ER either.

[liberated847]

According to the State of IL, PHRNs can do everything a Paramedic can do plus that of an RN.

I do know transport nurses (and RTs) from that state who do practice those skills inside of a hospital regularly to maintain their SCT skills. They are not APNs. Our Code and Rapid Response RNs (RTs) also have an expanded set of skills and education with a lot of protocols.

But, if you want to go down that road, there are many states which will not allow Paramedics to perform RSI or transport a patient which had medications or equipment outside of their limited scope of practice. RNs (or RTs) must accompany the patient. There are also places which will not allow Paramedics to intubate a child. There are other places which have removed ETI totally and will only allow for a King airway. Some places still do not have IOs on their ambulances.

We have a list of medications and equipment which a Paramedic can transport. It is not a very long list and if it is not on the list, a nurse, RT or CCT with a nurse or RT must transport. Again, these are not APNs.

Some IFT Paramedics have not intubated or started an IV in all the years they held that position. Some EMS Paramedics rarely get an intubation during a year. The sad thing is some do not even have the opportunity to practice this skill. You might also list surgical or needle crics but if most Paramedics are honest, it has been a long time since they reviewed the procedure and most will never perform some of the advanced skills in the field. I doubt if any Paramedic would ever be allowed to do a cric or needle a chest in an ER either.

I don't even know where to begin with the errors here. I think I'll just say this, Paramedics practice skills that are different because of their focus (prehospital). Can nurses do what paramedics do? Yes, can nurses do what doctors do? Yes, that doesn't mean they're trained to do it safely. If I'm sick and require long term care, I prefer a nurse, if I'm at the mall and go into cardiac arrest then give me a medic or EMT, keep the nurse away as chances are I'll end up brain dead in that setting