This post is not intended to knock paramedics because I know they do an important job, but I was just wondering if any of you have experienced this.
I work in ICU/CCU and the facility is going through some remodelling of the units so they have shut down a part of it to bring in the new equipment and stuff. Since the units are now functioning at about half their usual capacity they have been floating us out to tele and to the ER. I had never worked as an ER nurse before and I've never had much opportunity to work alongside paramedics so the nurse/paramedic relationship is all new to me. I've noticed since day one that the RNs and the paramedics in this ER hate one another but tolerate one another only because they have to, and they use every opportunity to make verbal snipes at one another.
The ER RNs say the paramedics who come through there do not respect them because they consider RNs to be patient aides. My preceptor there told me that the 'us against them' culture has existed for a long time and that nurses have been forced to stand up for themselves after taking many years of abuse from both the physicians and the paramedics. I'm pretty new in the ER and I've already heard many of the jokes and insinuations about how stupid nurses are, but I decided against getting involved in it. The nurse manager is the quiet type who lets things slide and does nothing to back up her nurses so the situation goes on and on.
Recently, I went to renew my ACLS certification and all of the instructors were paramedics. Just from listening to their derogatory jokes about nurses and patient care in emergency situations made me wonder if this is something that happens everywhere. Some of these guys really do believe that they know it all, and it is a joke to them that we call ourselves professionals. One of them even had the stones to ask if there were any physicians in the class because they've had "problems" in the past with physicians who questioned some of the things they say in their presentations. They all laughed about that because they thought it was funny for an MD to question their judgment about how to best stabilize a crashing patient in a specific scenario. I didn't think there was anything funny about that because no matter how experienced you are or how much you think you know, you can always learn something from another person, right? Apparently, not these guys.
The jokes were bad enough during the class that I had to say something to get them to stop, but even more alarming was the fact that so many nurses in the class were also laughing at these jokes that were intended to make us look foolish and incompetent. I wasn't going to say anything because I just wanted to get my certificate and get the heck out of there, but they crossed the line with the jokes when one of them suggested to another that only effeminate or gay men are nurses but that you had to be rough and tough to be one of them. Of course, I had to stop them right there, not just because I am not gay or because I am a man but because I just couldn't believe that these unprofessional louts were actually teaching an ACLS class.
I just don't get what's up with all this arrogance. I thought we were supposed to be working together as a team?
We all just gotta learn to get along. As someone who is active in both nursing and EMS, I can tell you that the misunderstandings, insults, and attacks happen on both sides of the fence. When I graduated nursing school, one of my EMS buddies asked me if I took the class where they taught nurses to be rude to medics. I told him that that was only an elective. He said it must be a popular elective but he was glad that I didn't take it. :)
Some friction some of the time is going to be unavoidable. If you're an LTC nurse, you generally only see medics under situations that are a little (and sometimes a LOT) stressful, where one mistake by either the nurse or the medic can be very obvious and very disastrous. If you're an ER nurse and you see the medics roll in, it means that another patient is about to be added to your already ridiculous patient assignment. As medics, we sometimes perceive nurses as the people who make us wait with our patients in the hallways and who criticize our care when we were doing our best in terrible conditions.
The nature of our interactions can really lend itself to conflict. Somehow though, we have to learn to smile, laugh (even at ourselves sometimes), and realize that we can only do our best.
A milk truck hits a minivan at a rural intersection. The force of the impact traps the teenage driver between the steering wheel and her seat, which in turn is jammed against a bent post. The patent's airway is compromised, she probably has a closed head injury and a likely tension pneumothorax. Extrication by a short-staffed, volunteer crew will take at least 30 mins.
Somebody has to climb in that van, secure the airway, decompress the chest, and start treating the head injury.
Understand this: The person who will attempt this, and be successful, will likely not be a shrinking violet.
I was a paramedic for a long time before becoming a nurse. Good paramedics are not always going to the most amiable folks. They tend to be very action-oriented and have little patience for those who aren't. The above scenario is no exageration. It really was encountered by a buddy of mine. He got in that van and went to work. Not something just anyone could have done. Sure, he's a little rough around the edges, but I wouldn't want him any other way. In his own way he advocates harder for his patient's than most nurses.
That having been said, there's a lot of paramedics out there who aren't cut of that sort of cloth. They're probably the ones who give nurses the hardest time. They see the really good medics behaving with a "devil-may-care" attitude and sort of adopt the swagger and the attitude. Usually they're a little younger and a lot louder.
Here, our EMS people generally get along very well with the hospital and nursing home staff. My biggest complaint from the paramedic point of view is when we are treated like we don't know anything or when we have nurses question what we are doing...not questioning to learn or just to understand out logic, but questioning like we are doing something wrong. People who have never been in the field have no idea what we do when we are out there. We've been to nursing homes and had the nurses tell us not to give the patient O2 because there isn't an order, we've had nurses tell us we could not have a med list because of HIPAA, and we've had nurses tell us we cannot transport until the patient is shaved or bathed or has their hair combed. It gets frustrating...we weren't called because there was a situation that could be handled when we get to the nursing home...we weren't called because things were going the way they should. We don't question the care you give once we drop a patient off and they become yours...you shouldn't question the care we give once we arrive and the patient becomes ours. As far as the hospitals go...paramedics take a lot more heat when they miss an IV or are unable to get a tube than nurses or doctors do. I have seen nurses look at paramedics like they are idiot when they miss a line WAY more than they do with other nurses. We have one physician who does such a sloppy job with intubation that I am hesitant to let him tube my manikin in ACLS class...he's chipped teeth twice that I know of and I have never seen him hit the trachea. The nurses just smile and let him try anyway and laugh about how good old Dr. _______ needs to take a class on airway management, but when a paramedic misses a tube, they talk about how incompetent they are and how they need their certification pulled.
I will never understand why there is so much disdain and contempt for each other in health care. The system would collapse if any group on the team failed to exist...paramedics do things RNs can't do...RNs do things paramedics can't do...LPNs and CNAs do things RNs don't have time for...it is a TEAM effort. We all need to work together and show respect for each other and the roles we play. We also need to realize that, in general, everyone is doing the best that they can do...paramedics shine in the field, but most are not cut out for dealing with a patient for a twelve hour shift...RNs kick butt in the ER but most don't do well in a rainstorm in the dark with a bunch of people standing around screaming because things aren't going the way they think they should.
Sometimes I think we all need a big old group hug and a beer...
That would make a lot of life nicer. :biere: :beercuphe :icon_hug: :icon_hug: Thanks. Next EMT I see. I'm gonna hug him, and thank him for the guts to take on the stuff he does.
RN's make $57K on average nationwide. Paramedics make $28K. This is why so many paramedics are going to nursing school.
So ... they can slam nurses all they want, we're taking it to the bank.
I too have met quite a few arrogant, rude paramedics. I think it starts in school. There's this highly competitive, machismo attitude that they're better than everybody else, which seems to be part of their culture.
Our EMTs are great- they even help roll or lift patients they didn't bring in if I ask for help while they are still here (middle of the night).
One of our ED docs married a flight nurse (she used to work our ED), and at the wedding EVERYONE was there, EMS, techs, Xray, nurses, docs, all our kids ... :balloons:
There are catty people in every profession and we in nursing have our share of them, too. But what I am talking about in the original post goes far above and beyond that. I am talking about deliberately going WAY out of your way to put somebody down and make them look bad, while at the same time presenting yourself as if you know everything and as if your skills are better than everyone else's. I respect and try to get along with everybody, but what I've observed in the behavior of some of the paramedics that I've had to deal with makes me understand why most of the guys and gals in our ER are so much on the defensive. Mind you, not all pramedics I've worked with are like this. Some are very pleasant and cooperative and do not have this attitude at all.
True it takes a lot of skill for a paramedic to cut into an MVA to intubate and stabilize a patient and all that; but, it takes a whole other level of skill for a tele RN to run around nonstop for 12 hours, simultaneously trying to keep 6 monitored patients from going bad; and it takes yet another level of skill for a physician to determine when established protocols will not result in a good outcome for a particular patient, to know when such a judgment call is appropriate and to quickly throw an alternative plan of care together sometimes with drugs that many of us have neither seen nor heard of before... It happens.
I don't care how action-oriented anyone is. RNs, Paramedics, and MDs all have different licenses because although our scopes of practice overlap they are different. Just because we're good at what we do doesn't give us a reason to ridicule other people. I'm rolling with Lizz's opinion on this one. People who have to put you down to elevate themselves are obviously attempting to compensate for something.
A milk truck hits a minivan at a rural intersection. The force of the impact traps the teenage driver between the steering wheel and her seat, which in turn is jammed against a bent post. The patent's airway is compromised, she probably has a closed head injury and a likely tension pneumothorax. Extrication by a short-staffed, volunteer crew will take at least 30 mins.
Somebody has to climb in that van, secure the airway, decompress the chest, and start treating the head injury.
Understand this: The person who will attempt this, and be successful, will likely not be a shrinking violet.
I was a paramedic for a long time before becoming a nurse. Good paramedics are not always going to the most amiable folks. They tend to be very action-oriented and have little patience for those who aren't. The above scenario is no exageration. It really was encountered by a buddy of mine. He got in that van and went to work. Not something just anyone could have done. Sure, he's a little rough around the edges, but I wouldn't want him any other way. In his own way he advocates harder for his patient's than most nurses.
That having been said, there's a lot of paramedics out there who aren't cut of that sort of cloth. They're probably the ones who give nurses the hardest time. They see the really good medics behaving with a "devil-may-care" attitude and sort of adopt the swagger and the attitude. Usually they're a little younger and a lot louder.
Pete Fitzpatrick
RN, CFRN, EMT-P
Writing from the Ninth Circle
I think this post gives a little taste of this alpha male " I am paramedic hear me roar " attitude ... I appreciate that there are medics out there that would do this kind of thing, I also appreciate the nurses and doctors that use their skills to keep them alive once they get to the hospital.
I wouldn't accept someone who has an attitude and is 'rough around the edges' if that means rude and feels entitled to be because of what they do in any circumstance.
None of us superheroes. We all have jobs and do the best to our ability ( hopefully ) , we are also coworkers and just because we are in the business of saving lives doesn't mean we are exempt from fostering good coworker relationships and working environments.
the american heart association pays us when we teach acls and they would certainly want to know about these instructors. they represent aha when they are teaching acls or pals, and aha would not want these unprofessional people representing them.
please email aha.org and inform them.
thank you!
My thoughts exactly! But aha.org is the American Hospital Association.
The American Heart Association has a "Student Comment Form" that can be completed and sent to the Regional AHA Office and/or AHA Training Center that sponsored the course. I would provide those addresses and numbers, but I don't know the locations of the aforementioned ACLS and PALS courses. I do have a copy of the form that can be emailed.
Please take the time to find the contact information in your area. Instructors such as the ones you describe give all of us a bad name. There is no place in clinical (or any type) education for such unprofessional behavior. I wonder how many students in these classes failed to learn the course content due to the poor learning environment.
The hospital where I worked employed their own paramedics, and they were great people. When I worked in ICU, they would come up occasionally to help with certain things.
My first nursing instructor told us to never stop at an accident if the paramedics were there. They've been trained to deal with those situations, and we weren't.
EricJRN, MSN, RN
1 Article; 6,683 Posts
We all just gotta learn to get along. As someone who is active in both nursing and EMS, I can tell you that the misunderstandings, insults, and attacks happen on both sides of the fence. When I graduated nursing school, one of my EMS buddies asked me if I took the class where they taught nurses to be rude to medics. I told him that that was only an elective. He said it must be a popular elective but he was glad that I didn't take it. :)
Some friction some of the time is going to be unavoidable. If you're an LTC nurse, you generally only see medics under situations that are a little (and sometimes a LOT) stressful, where one mistake by either the nurse or the medic can be very obvious and very disastrous. If you're an ER nurse and you see the medics roll in, it means that another patient is about to be added to your already ridiculous patient assignment. As medics, we sometimes perceive nurses as the people who make us wait with our patients in the hallways and who criticize our care when we were doing our best in terrible conditions.
The nature of our interactions can really lend itself to conflict. Somehow though, we have to learn to smile, laugh (even at ourselves sometimes), and realize that we can only do our best.