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RN vs. EMT

Posted
by TaylorJ TaylorJ (New) New Nurse

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?

HiddencatBSN, BSN

Specializes in Peds ED. Has 10 years experience.

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.

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.

HiddencatBSN, BSN

Specializes in Peds ED. Has 10 years experience.

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.

Sour Lemon

Has 9 years experience.

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.

TheLastUnicorn

Specializes in Critical Care, ICU, Rehab. Has 5 years experience.

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.

HiddencatBSN, BSN

Specializes in Peds ED. Has 10 years experience.

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.

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.

👍🏽🙂

Edited by JKL33

They smell your fear! 😉

^ EXACTLY.

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.

 

 

bsyrn, ASN, RN

Specializes in Peds, School Nurse, clinical instructor. Has 22 years experience.

 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.

 

Jairus Yui

Specializes in Emergency, Med-Surg, Acute, LTC. Has 3 years experience.

I have had to deal with condescending paramedics just today, I don't understand why they have to be like that. I have spent my school years of nursing for 4.5 and the paramedic was trying to tell me how Ventolin works, explaining CHF. Shook my head. Refused to take the patient with them which was ridiculous. 

SarHat17, ADN

Specializes in CVRU, Intermediate. Has 9 years experience.

On 8/14/2020 at 6:03 AM, HiddencatBSN said:

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.

I agree. I have no patience with this type of thing. Unless there is some sort of protocol where the EMT is supposed to collaborate with the attending RN and Dr, this EMT sounds out of bounds.

Well done listening to your gut and using your assessment/communication and advocating for the patient.

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

On 8/14/2020 at 12:23 AM, TaylorJ said:

 The EMT basically looks at my like I’m dumb. 

He basically made me feel like I had no idea what I was talking about.

 

On 8/14/2020 at 12:57 AM, TaylorJ said:

 But he kept trying to coax me into thinking maybe I had made the wrong call. 

With all due empathy and respect, TaylorJ, these are subjective interpretations and not objective facts. 

The facts are: An RN did assessment & followed through according with an MD's order put into action, which were strong links in a chain. 

The EMT was merely another link in the chain, albeit just not a strong one.

 

Been there,done that, ASN, RN

Has 33 years experience.

You did a great job with your patient. The M.D. ordered the oxygen and the transfer. The EMT is there to carry out the M.D. orders. That is not up to debate.   Your main mistake was taking the EMT's "suggestion" to take him off the oxygen.  Neither of you had the authority to change the O2  order. O2 is a drug.

I am sure your learned a lot from this episode, and in the future, any transfer will not be debated.

amoLucia

Specializes in LTC.

5 hours ago, Davey Do said:

 

..... The EMT was merely another link in the chain, albeit just not a strong one.

 

He was the 'weakest link'!

They just returned that TV game show again!

 

I would have just given him a blank stare and said "so which hospital are you taking the patient to?" I'm not here to argue with EMTs. I called, here's the patient and here's the situation and there's that. Done. Anything else or any argument made by the EMT is irrelevant. You're taking this patient and if you refuse I'm calling ALL EMT supervisors and documenting this encounter for future lawsuits because if something happens to this patient I'm not liable for it. That's usually the end of discussion. Zero time for egos and nonsense, especially when dealing with someone's life.