paraloco

Many years ago, my mom was a home health nurse. She married the husband of a cancer patient she had been taking care of after she died. I thought it was strange at the time, but my children liked him, and he liked them. I don't think any of his family knew to complain back then. Looking back, it was bad.

I'm a paramedic, and I am against it. For one, you are enabling an administrator to exploit you. Two, you are treading in to turf where more often than not, you are not wanted. Nurses should be against it too. Don't you want to protect the value of your degree?

Dixie McCall at Rampart General Hospital from the Emergency series in the 70's

The taxes in Beaumont are high, and if you want your kids indoctrinated into the street culture, send them to the public schools. They have good Catholic schools, and at least two other Protestant schools. There is alot of old money in Beaumont, and good places to shop and eat. Houston is not far away, nor is the beach. Stay away from the neighborhoods surrounding the campus to the north, west and south.(drug activity, several half-way house facilities) Directly east is a highway, with a refinery and chemical plants on the other side, then the Neches River. The west end is nice. Most apartment complexes are section 8 . A lot of high-dollar homes are going up. Right across the river(to the east) is Vidor.Vicodin-land. Not a bad place like you may have read about. Your housing dollar will go alot further in Orange County than in Beaumont, but you'll pay substantially more to live to the north, in Lumberton(Hardin County) . To the south are three decent bedroom communities, all intermingled with refineries and chemical plants. South of those lies Port Arthur, a little smaller but demographically similar to Beaumont. I have been a paramedic in the area for 18 years, 13 of them for the city of Beaumont. I don't live there. Gas is less than some other places. The heat & humidity are oppressive. For you culture- artsy-types there are museums, 2 performing arts theaters, a symphony, 2 ballet companies. There is a large entertainment complex to the west of town, with a large amphitheater, a coliseum where they play arena football and ice hockey, and a whole bunch of softball fields where teams from all over the nation come every year for a huge tournament. There are two hospitals, Memorial Hermann Baptist, and St. Elizabeth, both understaffed (at least in the E.D., where you will frequently find ambulance cots lining the hallways). It just depends what you are looking for. I don't know much about the nursing program. I am going to go there to get my BSN after I go through a paramedic to RN program at Lamar-Port Arthur. I can't imagine why they would not transfer your credit from UT. Lamar is hardly Harvard. Though they have built alot of new gated on-campus apartments(almost all the housing is either new, or re-modeled), alot of its students are commuters. Those who went off to the big-name schools, partied too much, and limped on home to live with mommy & daddy again. Or adults, looking to better themselves. They gave up on football years ago, still have basketball, and a sometimes-impressive baseball team.

I was searching specifically for a nursing listserv, to compare your issues to those of the paramedics. I find that many of the complaints/concerns about your jobs are the same as ours. I also found that the grammar and spelling here are no better than ours. I will soon be entering a nursing program at my local community college. This site gives me some insights into your world. I rarely see anything beyond the E.D.

My mother was a home health nurse, told me funny story. I hope I'm not leaving anything out. She was caring for an elderly man, post-cva. He had a poor memory also. The first day she was in his home and he asked for his smoking materials, my mother informed him " Mr. ----, you haven't smoked in years." I rolled when she imitated the puzzled look on his face when he replied, "I haven't?" But yes, he did, and the nurse my mother relieved didn't tell her that.

I'm getting prereq's outta the way for a medic to rn program. I ran a call this morning that made me doubt my decision a little. An elderly gentleman fell in his home, was almost completely covered with tarry black stool. He was as jaundiced as a yellow crayon. Anyway, we felt we had to clean him up some before transport. I can't imagine having to do that with any frequency. Then it occured to me. Techs do most of that kind of work in the hospitals in my area, female techs at that, whatever the patient's gender. I guess that is a plus to being a male in nursing. *wearing my asbestos thong panties in anticipation of flames*

Will they admit men?

I'll occasionally see a high-powered specialist in er, with his very attractive nurse in tow. I mean a b*tt ugly drooling nerd cardiologist with a super-model looking nurse, wearing very nice clothes with an immaculate lab coat. I've never seen a male, or an unattracive female with a specialist.

I would think it would be dependent on circumstances. For example, a young person commits a non-violent crime. Serves their time, probation, whatever. Never offends again. Goes to school to improve non-gender-specific self. Sure, give them a chance, or else we are saying that nobody is redeemable. Might as well give them a choice of being shot or being a ditch-digger/fast food worker forever. I saw in the news where there was a controversy about a convicted kidnapper becoming a doctor. He participated in a kidnapping where the victim was buried alive (found alive later) . This was back in the 70's, I think. He served all of his time. Then put himself through school. I don't have a problem with it, because he has so much to lose if he re-offends. This way, he's high-profile, pays taxes, supports the economy, etc..... I really wouldn't care if the 40-something year old RN caring for one of my family got busted for a joint when they were 18 years old.

I have respect for LTC nurses, I have an idea what their jobs are like. Most encounters (few now) are pleasant, LTC nurses are people too. The problem I had when I frequented LTC facilities was not with the rudeness or politeness of the staff. The problem was that we would recieve a call as shortness of breath, but find that the patient was cold, with dependent lividity. WTF?!! That was a frequent scenario. Or get called to a code, and find them doing compressions on a soft bed, with a simple face mask not attached to ANY O2 source (as if that would have made a difference) and NO ventilations. Or (not the LTC facility's fault, but still annoying), getting the call for abdominal pain from a private EMS, to arrive and find that its really a g-tube replacement transfer. They would rather tie up a 911 med unit than let one of their competitors get a foot in the door at 'their' facility, cuz who knows how much candy, doughnuts, pens, coffee cups, (and yes, 'love') they hadda spread around to get the facility's business. Don't get me started on private EMS. Once again, LTC nurses are people, worthy of respect.

I have several reasons, all have varying degrees of importance. I have a caring attitude toward others most of the time, and even when I don't, I'm good at faking it. I have the aptitude and the skills to do the job well, and have proven myself under pressure for many years. I need the money, which is one heck of a lot more than what I make now in EMS, with(according to a friend of mine who is a medic, then became a flight and ICU nurse) about 1/8 the responsibility. I'm tired of a soul-crushing work load, with the knowledge that one unfortunate injury could end my livelihood, with not much more than "sorry" from my employer. I'm tired of sleep deprivation, and can't imagine another 20 years at the pace I've been keeping. I have 3 young teenagers, one now driving, and 2 more within 2 years, all three in college within 5 years.

I'll never forget the time I picked up one particular overdose patient. We woke her with narcan, she became combative enroute. After moving her to the bed in the ED, she offered to bite the charge nurse. The nurse snarled: "Bite me, and you'll be replacing your teeth!" I hadda leave to laugh! You should have seen the woman's face.

That perked me up too! If I have a combative head-injured patient, a combative patient in fulminating pulmonary edema, whatever, the only restraint necessary might be until the IV is secured, and I can sedate, then paralyze them. I don't do it just because I can, or because its 'cool' or 'b*tchin'. I had a 14 year old in status epilepticus. Even after the valium stopped the seizure, he was clenching his teeth, was choking on secretions that I couldn't get at with a Yankeur tip. I nasally intubated him, transported without incident, and he was discharged later in the day, rather than being in ICU on a vent like he would have been if I had RSI'd him.

A littman, or littman wannabe(as long as it has vinyl tubing) Latex tubing transmits too much environmental noise, such as you would find in an ambulance, or helicopter.

I can't remember a time when I didn't have a high-pitch whine in both ears. Even as a child. I try to tune it out. My hearing has definitely suffered after 17 years of sirens blaring.

I had no idea there was such a specialization. I became a registered massage therapist about 7 years ago, but have never gone into practice ,save for one brief period. When I become a nurse, is there a separate curriculum for NMT'S that I must take?

I believe that what holds EMS back the most is that Medicare only pays a pittance for our services, and medicaid and the insurance companies follow medicare. The private EMS company owners make money hand over fist, but pay as little as they can get away with. They have associations which would step in to help if the employees ever rose up to demand better working conditions. There's not enough unity among the medics to get anything meaningful done. There's a big contoversy going on about a National Scope of Practice for EMS. It would take the pressure off the big-city fire department systems to improve their standard of care. Most of the guys on those units dream of a time when they have enough seniority to bid onto a pumper. I have long suspected that EMS would reach a point where a political decission would have to be made to either increase its scope (through increased education standards), or dial it back. As we have increased our capabilities and the quality of care that we deliver in the field, we have developed EMS into something of great value to us, but this value is not shared by others. That puts us in a unhappy situation. I am 40, have been in EMS 21 years (17 of those continuously at the paramedic level), and I love my job. However, I have 3 kids who will all be of college age within 5 years, and I have reluctantly come to believe that my financial needs will never be met by EMS. I don't have delusions that I will become rich by becoming a nurse, but I know that I could easily make 55k+/year with very little extra overtime. That's more than I've ever made in my life. I'm about topped out at 45k (not bad IMHO). I know many medics who have become rn's, they all miss the street, but can't walk away from the rn pay. I'm going to do both(only 9 years to EMS retirement) for a while. In the next couple of years, I see a mass exodus from EMS to nursing. I really hope we have trained the young ones well for the burden that will be on their shoulders.

I know of 2 programs in my area. One of them is at Lamar State College Port Arthur, the other at San Jacinto College North. I think both take 1 year. The one in Port Arthur does not work around your EMS schedule. I know a few medics in it. A couple of em tried Excelsior, 1 failed the CPNE 3 times. There's a new way also. A group out of Indiana is approaching EMS instructors, setting up classes where you go to class twice a week, and basically get spoon-fed everything you need to know to pass the nursing tests and the CPNE. There's one of these places in Deer Park, Texas. Jerry Reichel is about to open another office in Beaumont. Depending on how many classes you need, it may run up to 12,000 big ones, but it is supposedly all-inclusive. Come on, we are hurting for medics.

that post really shook me for a bit. All my former co-workers who have gone thru EC have done very well in our area, most becoming charge nurses, or flying with air rescue. I do have to wonder if BSRNs feel resentment at 2 year rn's making as much. Seems like they'd wanna protect their investment in their educations

Rales sound thin and watery, you usually hear them first in the lower lobes. History helps too. If the patient suddenly woke up in the middle of the night with dyspnea, has a history of hypertension and the associated meds, no fever, and JVD bilaterally, think rales. If you hear thick secretions in isolated patches, think rhonchi. Rales will be uniform. So, try this. Get a focused history first, then ascultate.

Go join the TExas EMS listserv. It's almost all they talk about now. Its a proposal for a National Scope of Practice. Alot of big city fire department EMS systems would welcome it, because it would take the pressure off of them to increase their capabilities. Privates would like it, because they may be able to reduce the amount of meds and equipment they have to buy. For the more advanced systems, it would be a taking some large steps backward. The medical director we have takes an active role in our QA/QI. We also do frequent CE , 'merit badge' courses ACLS BTLS PALS PEPP He lets us do alot because its not as hard for him to keep tabs on us as it would be a for the medical director of, say, Houston Fire Dept., to keep up with all the guys he is responsible for. The National Scope of Practice as it is envisioned by The National Registry of EMT's would take away an individual medical director's discretion to pick and choose what he/she/it want the medics to do. If enacted, those who choose to ignore it would leave themselves exposed for some serious liablity

We use Etomidate and sux also. If we need to re-sedate prior to arrival, we give em another 20 of sux. If its a dialysis patient, and one with burns or crush injuries over 24 hours old(when would we run into this?) we would use vec. I have heard that Ketamine works well.

I was a private service medic for 6 years, and I do not remember those days with fondness. We had to be kiss-*ss sweet to all facility staff, regardless of whatever rudeness they felt like dishing out(and there were a few with soap-opera lives who liked to vent on a helpless target). The owner toadied up to these folks, because he owed his business on their good will. But, Ya know, ya can't really respect someone who kisses your *ss just to get along. We have a great relationship with our nurses, based on mutual respect and understanding.

We have different priorities than nurses. We do some things that may make a patient's hospital stay longer and more arduous, but that on scene are necessary. RSII comes to mind. It can be over-used, but it is a very useful tool. We rarely have to worry about much beyond airway management, breathing, and circulation, and the interventions to correct all 3. About 6 years ago, we started using differential based protocols, in which we must come to a differential diagnosis based on our assessments. DUH However, we find ourselves with many patients who do not match up with any particular protocol page. Pleurisy, for example. We are encouraged to be aggressive, and do whatever needs to be done, as long as we can justify it on paper. If I can unload in triage I will, because I know that the ER frequently has to hold onto patients for a long time. Some of my co-workers don't care, and that's unfortunate because we all have to take care of each other.