RN vs. EMT

[TaylorJ]

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?

[Jairus Yui]

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, ASN, RN]

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]

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]

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]

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!

 

[NurseBlaq]

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.

[FolksBtrippin, BSN, RN]

You did the right thing. Sorry the EMT behaved that way. 

[DaniDarya, EMT-B]

I can only guess the EMT has been criticized by their company for transporting well patients. As an EMT you don't really have much autonomy to not take a patient even if you don't think they require emergency care. At least that's how it goes in CA.

Looks like others have already covered the bases. You did your job, no need for them to question it. Report the incident.

[Nurse SMS, MSN, RN]

See this a lot with EMTs. I don't know what causes it. Some say it is because they think they do everything we do but get paid less. Some say its because nurses are mean. Some say its ego. Some say its because they don't value the elderly. I have zero idea.

Next time invite him to contact the physician to question the orders but do it on the way because you have other patients to see to in the meantime.