tension between EMT and LTC nurses?

Lmoynihan · Sep 15, 2004

Hi,

I hope I can address some things for you. I am both a Paramedic and a Nurse. I agree that there is a lot of bad blood between nurses and Paramedics. Part of the reason, I think, is that the fields are so DIFFERENT.

People assume since it's medicine they are related. The're NOT. Nurses are taught a very broad range of things, but nothing truly in depth. Paramedics are taught a much smaller range but the things we are taught are very indepth. The emergency medicine I was taught in nursing school only took a week or so. Paramedics take at least a full year to learn nothing but emergency medicine. On the other hand we are taught almost nothing of the other aspects of nursing. Part of the problem too, is that the info you get as a nurse sometimes contradicts what you're taught as a Paramedic.So unfortunatly Paramedics assume that nurses are not as smart and Paramedics are egotistical( that comes with the nature of the job). But the bottom line should be ...We all need to repect the education and experiences that each other have. I hope this helped alittle.

i was reading some of the prehospital forum on a different medical board hoping to get some info and insight into their job because if there is a lag time between finishing my rn prereqs i have been thinking i might enroll in the emt-b program, to get a heads up on a few skills. Anyway i was really disappointed to see the disrespectful posts regarding nurses and in particular LTC nurses. I have considered the source of course (because the board is a part of SDN), but i still was surprised at the overwhelming belief that nurses are not as well educated as paramedics or even emts. (among the ems providers this seemed to be the consensus at least) At my school the RN program not only has more gen ed requirements and (higher levels at that) but more science such as chemistry and microbiology and nutrition., so i don't quite understand where this idea of nurses knowing less is coming from. I guess i am just disappointed to see other non-doctor medical personnel downing nursing. I think that everyone has a vital role and don't see why the bashing is necessary.

Lmoynihan · Sep 15, 2004

I unstand what you're saying and respect your opinion. As a Nurse and a Paramedic I hear it from both sides. There are stupid, ill trained, arrogant Paramedics AND Nurse. No one profession holds the corner market. As for who's better... Neither. Different doesn't mean better or worse..it means DIFFERENT. As far as taking a nurse over a Paramedic any time...that depends on the situation. If I'm in a bad car accident and need an emergency airway, PLEASE send me a Paramedic. On the other hand if I'm in a hospital and need nursing care PLEASE send a nurse.

EMT/Paramedics and LTC nurses have vastly different roles. The RN has a clear knowledge base superiority. How ever it must be understood that these two groups of people serve very different functions. How ever to the EMT/Paramedics who think you are so much better educated, listen to your radio when getting medical direction.....It is in many cases an ICU/CCU/Trauma based RN/NP that is giving your the direction you require to do your function. I hope they don't want to try and take on Corrections Nurses.
PA-C in Texas you have some things to learn. First you need to change your attitude. What are you doing in a nurses forum anyway? I have worked as an EMT/Paramedic and as a flight nurse. I was a nurse in the Army and privilidges beyond any Paramedic. You cannot contrast people who work in different environments. A Field Trained or RN/Flight Nurse is better able to function and is more independent than a Paramedic. Just a little food for thought.......I'll take the nurse any time. Kind of like I want an MD not a PA. Who there is better trained?

emsboss · Sep 16, 2004

I unstand what you're saying and respect your opinion. As a Nurse and a Paramedic I hear it from both sides. There are stupid, ill trained, arrogant Paramedics AND Nurse. No one profession holds the corner market. As for who's better... Neither. Different doesn't mean better or worse..it means DIFFERENT. As far as taking a nurse over a Paramedic any time...that depends on the situation. If I'm in a bad car accident and need an emergency airway, PLEASE send me a Paramedic. On the other hand if I'm in a hospital and need nursing care PLEASE send a nurse.

I have spent a loooong time reading this thread...and...I have decided that there will ALWAYS be emnity between EMS and Nurses...or, lest I offend any one...Nurses and EMS...I would like to say that they are two different schools of thought. Or you could say two different disciplines. The 'medics are taught/trained to react to a situation, yes, we have protocols and algorhythms(sp?) to go by, byt we have to deviate once in a while...So...We are not just "trained"

Nurses, are taught to think beyond just the primary "diagnosis" and to look at the "at risk for" problems. So, what we have, IMHO, is a case of "apples v. oranges."

LadyMadonna · Sep 17, 2004

Maybe the EMTs are just hacked off because it is not a trauma case that most tend to thrive on. Either that, or they have some sort of inferiority complex that they are working through.
Don't worry...EMT's are equally rude to their patients. I was in an accident, my face badly burned, blind as a bat. I was in extreme agony, and when I asked for something to put on my face, I got yelled at by the EMT for being impatient. Well, EXCUSE ME BUTTHOLE, BUT IT IS NOT YOUR FACE THAT FEELS LIKE SOMEONE THREW ACID ON!!!

I was at one of my night classes at the college tonight. Down the hall they are having an EMT course and one of the instructors (I have to admit) is a pretty good-looking, well-built guy. As I was walking into the class this instructor was out in the hall in his EMT

"costume":chuckle :uhoh3: ....anyway, I see these two giddy freshman girls giggling away and turning mushy...this EMT was eating it up, strutting around like a banty rooster :rolleyes: (as annoyed as I was, he sure could strut... )

Ahem...but anyway, I have not really had any run ins with EMTs in LTC. So far when I have had to call the ambulance they have been pretty friendly, though I do work in a small town. Could have something to do with it.

mattsmom81 · Sep 17, 2004

I suspect the disrespect is actually jealousy due to pay discrepancies...as many EMT's think they are more valuable than the average nurse. JMHO.

coocooclown · Jan 15, 2005

FYI the hiarcheal order is RN then Paramedic then EMT.
What The EMT and Para do not comprehend is the complexity and range of nursing.
LTC is a very different focus than emergency or even acute care.
Emergency care is based on algarythms. EMTs and paras memorize these because basically they do not deviate from them.
Acute nurse (even much more than emergency nurses) use critical thinking more and use them when applying algarythms. The nurses education is more extensive and complete than the para.
The para has ONE very narrow focus in thier entire education, emergency care.
Your education is much broader and more involved.
In emergencies they are the expert.
However. to dis a LTC nurse because her emergency skills are not up to par of some one who works only in emergency is like diss'ing an obstetrition because he cannot do heart surgery.
Thier ignorance stems from the fact that they do not know what they do not know. They are contstantly required to act in emergency conditions and have had to memorize protochols so that they are automatic without thinking. and working in emergency give these folks a false sense of being some kind of superior care giver because "they save lives".
All they really do is keep a situation as controlled as possible UNTIL the real care and life saving can take place.
Often they are adrenaline junkies, with a hero complex. Sorry, but I have had the misfortune of sitting in a firehouse listening to these self proclaimed heros tell the same story over and over such as about how they put in an IV on the fly (an event that took place over 2 years privious) To them that is a major big deal, worth repeating to every one who had an ear.
They do a lot of talking and patting self on back.
So how can they possible respect someone who has the job of a mere mortal and does not deal with life and death emergency every day.
I think much of the critcism about transporting DRNs etc it the funding. Unless they do certain procedures during trasport they do not receive funding for that run.
We have mostly volunteer emergency response here. However, there are several medical transport companines that are not emergency but do provide medical transport for patients. maybe this is who we should be calling. However they are not available on a moment's notice.

Hmmm....you have a very interesting perspective about ems. Sure there are a few Bubbas out there in the local firehouses that think that a non-rebreathing mask and rapid transport are the only treatments that a pt with COPD exacerbation or pulmonay edema secondary to CHF require.

But, as a paramedic student, I was exposed to nearly ever department in the hospital. In all 500 clinical hours minimum were required to complete the program. I rotated through pathology, lab, or, l and d, er, icu, ccu, pediatric icu, lifeflight, etc... And by saying that paramedics are not required to think proves to me that you don't know the definition of critical thinking.

I was taught that protocols are guidelines and that one must use.....critical thinking to decide whether the patient in question will benefit from the treatment guidelines.

You display many fallacies of thinking by generalizing paramedics into one category: That we are brainless trained monkeys that have been handed an ET tube and cardiac drugs. Many of my family members are nurses including my mother, whom I have a lot of respect for. I also plan to complete my nursing degree through EC.

We aren't just adrenaline junkies. I have spent many hours talking suicidal people into going to the hospital for treatment, delivered babies, fixed grandma milk and cookies after taking her to the hospital for N/V, assisted nurses and techs with code browns (nope, I don't think I'm above treating someone like a human being) and talked to elderly women and men at 2:30 AM, who called an ambulance because she was lonely and having a panic attack.

But I have also pulled mangled bodies out of cars, told sons and daughters that mom can't be saved, told mom and dad that their daughter couldn't be saved, as just a typical day in ems. Oh and by the way, as I'm sure you know, rapid sequence intubation is a skill that carries immense responsibility and liability, and many paramedics carry that skill and use it on a regular basis.

I pray that my words will somehow change your "critical thinking" skills, about paramedics. The next time you sit through a pals, acls, phtls, btls, nals etc....beware....many of your instructors will probably be paramedics.(many will be future physicians as well)

Sincerely,

AJO....EMT-P

I was taught that the correct spelling is algorithim. Maybe there is more than one spelling.

coocooclown · Jan 15, 2005

Over the years I have also had several "encounters" with EMS personnel. They are consistently rude to the patient, family and the nurse. I am not sure why they have the sense of superority over nurses, but it has caused the death of several patients I know. I had one incident where I was working an agency shift at a nursing home. I am mainly an acute care nurse, but needed the extra money. Patient fell and smashed his head really bad. Initial assessment showed some minor neuro changes and I felt it best to send him to the hospital for further evaluation. He was a DNR. However, from my perspective, DNR or not, he fell and needed to be seen by a physician. When EMS arrived to the facility, I was giving them report and they took a brief look at the patient and said that he was fine and they would not be transporting him. I told them that if I had to carry the patient on my back, he was going to the hospital. The EMT and the paramedic laughed as if this situation was a joke. By this point, the patient had some significant neuro changes and I was concerned that he had a subdural hematoma and was continuing to bleed. I actualy had to call the supervisor for the Paramedic to get them to transport the patient. Unfortunately, the patient did die at the hospital several hours later, but how horrible that EMS personnel feel like they can play God, just because the patient has a DNR order. I am sorry .... but nurses are better educated and in many cases have a more comprehensive understanding of the patient. EMS just sees a glimpse of what we see and should learn to rely on our assessment of the patient.

UGH....here we go again. Not all paramedics and emts are this way. Please don't generalize us like that. Yes we have our share of jerks, but most of us aren't this way. I can assure you.

AJO...EMT-P

coocooclown · Jan 15, 2005

one time i had the pleasure of an encounter w/an emt whose arrogance, disrespect and total disruptiveness on my floor resulted in my commanding his professionalism and to just do his damn job. the smart *** he thought he was, he turned around and reported me for "delay of treatment" w/my very sick pt. i proved this jerk wrong; his buddies would not stick up for him (they're not all bad) and i have a formal letter of apology from his boss with assurance that he was fired. i would have to say that 85% of my encounters are pretty negative. i don't know how long their training is but basic courteousy should be incorporated into their curriculum.

Where I live it is now an associate degree program. So yes...we are educated. EMT curriculum is roughly three semesters.

coocooclown · Jan 15, 2005

[nurses less edu. than emt or paramedics4navy :rotfl:
hello,
dont be discouraged of some you think emt--paramedics more educated. they're trained in a 6wk--3month course for emergent episodes, to carry the patient to the next highest level of care.nurses and doctors, surgeons ans specialists. haaaaaahahhahahahahahaaaaaaaahaaaa----thats a good one. but, we're all in a tight knit circle together, we need each part. truly---take care, good luck in whatever venue you work
:chuckle

6 weeks?????.....where can one get paramedic training in 6 weeks?....where i live, you can't get an emt education in 6 weeks. i don't know where you live, but you are wrong if you think that paramedics go to school for 6 weeks. try 18 mos minimum.

coocooclown · Jan 15, 2005

I do walk in their shoes, and ALWAYS give a thorough report to the paramedic (we rarely use 911, instead we call an ambo company, unless, of course, a CVA is evolving right in front of us).
I also send ALL H&Ps, MARs, TARs, Vital signs, face sheet, Advanced directive copies, then call a phone patch to the ED charge nurse.
Now, I am the house charge, and don't have a patient assignment (aside from IVs), so it's easy for me to do this...BUT, night shift is the ONLY time the house charge has a med cart, but rarely has any scheduled meds, so she has plenty of time...
sean

You sound like an awesome nurse. I find all patients fascinating as a paramedic. Whether it be a pneumothorax secondary to a chest to steering wheel collision, right down to replacement of a foley catheter. Something can be learned from every call. And a nurse such as yourself, makes a paramedics job much easier (as I'm sure you know). Getting a good report, necessary paperwork, and knowing the answers to questions makes patient care sooo much more effective. But I DO understand why an LTC nurse doesn't immediately know all the meds and allergies. With that many patients, it is impossible.

Thank you for being a good nurse

ao...emt-p

coocooclown · Jan 15, 2005

Happened to me a few weeks ago... I had a few bad situations all at once....First one a resident fell in bathroom (of course blood everywhere), looked like a hip fx and laceration on shoulder also c/o sob and chest pain....down the other hall at the same time 2nd resident with BS below 40 and unresponsive. Meanwhile my two favorite alz pts were at the doors trying to escape (2 of them at different doors). It was a mess, call bells ringing, door alarms ringing and it was the 11-7 shift with only me (RN) and 2 CNAs and 50 residents. (Mind you I'm 39 weeks pregnant and as big as the side of a house!) Needless to say 911 was called for both (full codes). I was unable to "meet" each crew and give them a full indepth history, but they got the rundown... (lucky I had my cell phone that night) paperwork was a little sloppy (ended up faxing it to the hosp). The EMTs and paramedics that responded that night were ANGELS (Probably worried I'd pop my baby out right there!)
Just a little look into what can happen in a LTC with "appropriate" staffing, when things go wrong.

Good work Michelle....it sounds like you were having the shift from hell. :devil:

Thank you for all you do for humanity.

ao emtp

coocooclown · Jan 15, 2005

Many of the nurses at an assisted living facility I used to work at have had bad reports about the EMT's when they arrive. Sometimes the nurses don't know the meds these Pts. take because they self admimister. It's their home. So when the nurse responds to an emergency in someone's apartment, she responds as if she is finding someone in their own home.
On a personal note, when I was called to my 7yr old's school because she was dizzy and falling down and was unsafe to put her on the bus, I came to find her verbally unreponsive, sitting on the floor, falling over every which way, couldn't hold her head up, abnormal movements. Very scary. When the EMT's arrived (15 min. later), as soon as they heard my baby had a mental illness, they said, oh, well that's a behavioral thing, there's nothing we can do about that. Excuse, me, someone with a mental illness can't be sick, or as in her case toxic from her medication, which I informed them she had an increase of dose and had not eaten in 2 days. I could not drive her safely in her condition. At least the ambulance gave us a ride home, so I could observe her while I decided what I wanted to do. What a nightmare!

Yes, to expect a nurse in LTC to know all the patients medications is just plain ignorance. I will agree with an earlier post that education about the protocols for resident transports , for ems would be beneficial.