RN vs. EMT

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I’ll start off by saying I am a new nurse. I’ve only been working for a few weeks.I work in a LTC facility that has been turned into a covid unit. We only have COVID Patients. One of my residents starts to decline. He has a j tube. His sats have always been at least 97 or above up until tonight. We’ve had issues with him vomiting and we’ve been concerned about him aspirating. I walk into the room and he is coughing. His O2 sat was at 92. He begins coughing more and it goes down to 88. I suction him and turn his O2 up to 5L. It was originally at 2L via nasal cannula. I can’t get his O2 sat above 91 at this point. I decided to call the doctor and we both agreed to send him to the hospital. I turn O2 up to 15L and put him on a nonrebreather mask. Once the ambulance gets there, I give the EMT report. At this point my patient is now sating @ 99%. The EMT basically looks at my like I’m dumb. “Well he’s sating fine now” is what he told me. I mean yeah he’s right but he was also on 15L. This EMT didn’t want to take him. He suggests we take him off the O2 to see if his sats go down, I guess he was trying to prove his point but he only proved mine. within 3 minutes he’s back down to 90%. He basically made me feel like I had no idea what I was talking about. I see this resident almost everyday. I know what his norms are. This was not normal for him. The MD and I came to a mutual decision to send him to the hospital because he’s not doing good. And this EMT waltzes in like he knows everything about my patient. As a new nurse it was hard for me to stick up for myself. I felt like maybe I had made the wrong decision to call 911 even tho I knew it was the right choice. Is this an issue that often occurs with other healthcare professionals such as EMTs? Did I make the right call?

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Specializes in Peds ED.

Someone needs fo follow up with the squad that EMT works with. They don’t get to refuse to take a patient because they think they don’t need the ER.

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7 minutes ago, HiddencatBSN said:

Someone needs fo follow up with the squad that EMT works with. They don’t get to refuse to take a patient because they think they don’t need the ER.

He never directly refused to take the patient. But he kept trying to coax me into thinking maybe I had made the wrong call. He kept pointing out that his O2 sat was at 99% when they got there. I also pointed out that he was on High flow oxygen and thats why they were so high. Within minutes of taking him off of it, his sats dropped down to 90. and they probably would have gone lower if we had left him off O2 any longer.

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Specializes in Peds ED.

Just stick to the facts then. I’d refuse to take the oxygen off: they can noodle with the settings on the way in to see if he desats or not.

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1 hour ago, TaylorJ said:

I’ll start off by saying I am a new nurse. I’ve only been working for a few weeks.I work in a LTC facility that has been turned into a covid unit. We only have COVID Patients. One of my residents starts to decline. He has a j tube. His sats have always been at least 97 or above up until tonight. We’ve had issues with him vomiting and we’ve been concerned about him aspirating. I walk into the room and he is coughing. His O2 sat was at 92. He begins coughing more and it goes down to 88. I suction him and turn his O2 up to 5L. It was originally at 2L via nasal cannula. I can’t get his O2 sat above 91 at this point. I decided to call the doctor and we both agreed to send him to the hospital. I turn O2 up to 15L and put him on a nonrebreather mask. Once the ambulance gets there, I give the EMT report. At this point my patient is now sating @ 99%. The EMT basically looks at my like I’m dumb. “Well he’s sating fine now” is what he told me. I mean yeah he’s right but he was also on 15L. This EMT didn’t want to take him. He suggests we take him off the O2 to see if his sats go down, I guess he was trying to prove his point but he only proved mine. within 3 minutes he’s back down to 90%. He basically made me feel like I had no idea what I was talking about. I see this resident almost everyday. I know what his norms are. This was not normal for him. The MD and I came to a mutual decision to send him to the hospital because he’s not doing good. And this EMT waltzes in like he knows everything about my patient. As a new nurse it was hard for me to stick up for myself. I felt like maybe I had made the wrong decision to call 911 even tho I knew it was the right choice. Is this an issue that often occurs with other healthcare professionals such as EMTs? Did I make the right call?

I have never worked in LTC, but I've heard lots of stories like this from nurses who have.

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Specializes in Critical Care, ICU, Rehab.

This would happen anytime I called EMS for a patient when I worked LTC/SAR. The EMT would even try to pursuade the patient that they didn't need to go to the ER. I finally got so fed up I just started calling the EMS company or hospital / whatever service they were with, right in front of them, and ask to speak with a supervisor. Especially if I had already told them the MD ordered it and they'd keep fussing.

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Specializes in Peds ED.

I would just reiterate the assessment, that the patient has had an acute change and is now requiring high flow oxygen to maintain sats, and the doctor has ordered transport to the hospital and then directly ask if they are refusing to transport the patient.

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6 hours ago, TaylorJ said:

The EMT basically looks at my like I’m dumb. “Well he’s sating fine now” is what he told me.

Stay calm.

6 hours ago, TaylorJ said:

He suggests we take him off the O2 to see if his sats go down,

"I've already done my assessment and spoken with the physician. I'm not doing that and I'm not going to argue about this."

6 hours ago, TaylorJ said:

He basically made me feel like I had no idea what I was talking about. I see this resident almost everyday. I know what his norms are. This was not normal for him. The MD and I came to a mutual decision to send him to the hospital because he’s not doing good.

I mean this kindly: Reread what you wrote about your care of this patient: 1) see resident daily 2) know norms 3) recognize abnormality 4) inform physician 5) participate in decision-making that result in decision for further eval.

You did exactly what you were supposed to do. Therefore, it doesn't matter who stood there arguing with you, it doesn't have to "make you feel" the way you felt. This other individual doesn't know what they're talking about. Their ignorance does not dictate your emotions--you do! End of story. ??

I would not entertain this in the slightest. Carry yourself with purpose, speak concisely. When EMS arrives, hustle to the room with the paperwork, introduce yourself like a professional and make good eye contact; give them your brief and decisive-sounding report. Ask if they have any questions (common courtesy, good patient care). If at that point the reply is push-back like, "well he's satting good now" you say, "Yep. He's on 15 liters of oxygen." Any more malarkey after that is when you say, "I've spoken with the physician and I'm not arguing with you about this." Lastly, when you have made this statement then don't just stand there passively as if you are going to entertain more foolishness. Move away - either out the door of the room, a few steps down the hall or back to the nurses station or whatever is appropriate for the patient scenario.

Your confidence will increase with time but you must work on emotional control so that you don't have a self esteem crisis due to someone's ignorant and/or lazy foolishness.

???

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They smell your fear! ?

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^ EXACTLY.

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On 8/14/2020 at 3:51 AM, TheLastUnicorn said:

I've experienced this a few times working in SNF. They like to put their 2 cents in and take their time to do their assessments with no sense of urgency when clearly resident is having a hard time breathing. Next time I'm just going to be blunt with them. I have a MD order to send the resident out for COC, would you like to speak to him and give him your assessments? These ones were clearly unprofessional and failed to recognize someone in respiratory distress. They were obsess with the numbers and measurements that they don't even look at the patient.

 

 

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Specializes in Peds, School Nurse, clinical instructor.

 A lot of EMT's don't think nursing home nurses know anything. Don't feel bad, they don't think school nurses know anything either. Just stick to your guns, and know that you are doing what is right for your resident.

 

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