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tension between EMT and LTC nurses?

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I think my greatest tension between myself when practicing as a paramedic and the LTC nursing staff was that in 25 yrs of EMS I can count on one hand the number of times I have been met in the pt's room by the pt's nurse and given a decent report. The vast majority of the time I have been waved past the nurses station or had a room number shouted out me, only to find two, or even three elderly people with what I would diagnose as altered mental status. I always have to send my partner back out to the nurses station to find the nurse, then they send one down who gives the old song and dance about "this isn't my patient, I don't usually work on this floor, wing etc" "Why are you asking me all these questions?" You know stuff like, hx allergies, meds, baseline mental status. They never have the paperwork ready for you. The pt has been suffering with this condition for hours while they tried to contact the MD, but no one has had the foresight to copy his chart. Then they seal it in an envelope and tell you not to open it, only the Hospital can have that info. They entire time they're shooshing you out the door like a flock of recalcitrant chickens. And don't even start me on the times I've had to do simple things like suction a patient, or give a diabetic with a BS of 26 (which they hadn't caught) an amp of D50 while they stood around, clucked their tongues and tapped their shoes because " I was playing doctor"

It always seemed that instead being part of the continuum of care for this pt that me and my crew and even the pt were a major inconvenience for them. I've taken pt's out of LTC's in three states and it never varies.

HAHA...if youre like me I ALWAYS open the envelope. Someone would be wasting their breath to tell me not to open it. I have a responsibility to the receiving facility to give them a heads up about what is going on with the patient. It is what is expected of us.

ao...emtp

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CAN WE SAY LONG...LOL! But excellent info :)

I find almost all the paramedics and EMT's I know personally have as much education and training as I do, just in a different scope of the practice is all. Where I am considered LTC RN, I have only been treated rudely a few times, and proably more because I am taking things personally than anything! I treat them like they are part of my patients team..and I feel that is the way it should go, even if I have to force myself into the picture from time to time to get listened to!

Since I am married to a paramedic, I get a bit of a more open responce from those that know me in our para/ems (and a ton of info about what they do, what is going to go on, and how I can assist!)! When I have time, and I am quick to start with...I get all my patients MAR's, Face sheets, POLST's, and any new info photocopied and ready for them as they are coming in (which sometimes is 2 mins! I am very lucky to have a post 6 blocks away!).

I scan over their charts to see what has been added since I was gone (I am in assisted living...160 patients, not like I know every detail when I work part time..LOL!), and give them a quick report of the situation as I am walking them in (or in cases of CPR, report is either delayed or on the fly with what info I know). I find that if you can at least help with getting medication lists together and a DNR/POLST it really helps!

When a nurse gives a paramedic/emt a report or a situation, it is considered transfer of care (and vice versa!)...so basically at that point I have given my consent to those paramedics/emts to do their job...something Nurses tend to forget. It doesn't mean you no longer can help or advise (and I strongly suggest keeping things to just info, not advise about what they should be doing!!!), but you have handed over care to them because...heck, you called them in the first place showing you need their expertise so that one is a no brainer, so it is their patient at this point...just stand by info/assist is the best thing you can do.

Things that help

1. Make sure you have all medications and treatments copied or known to tell them.

2. If there is a DNR, get the ORIGINAL...they must see the ORIGINAL, but some states say that after they see that, they can take a copy with them...but they have to actually see that original!

3. Move out large obstructions from a gurney path..take in mind large kits too! Only do this if it doesn't harm, or even move certain patients.

4. Do not allow patients to drink/eat or even go to the bathroom, at this point they are an emergency patient so basically a lay down and wait deal so they don't get harmed or complicate matters once they are in the ED!

5. Be to the point, they don't need info on how nice a patient is, maybe if they are combative, or have any behavioral/memory probelms..but not general chit chat! I go age, sex, general history, current complain/situation, and when it started...then up for questions with chart in hand (and my caregivers since they know the patient best!).

6. No time for rubber necking...be there for info, but stay out of the way basically and let them do their tasks/assessments. This is especially important for family that may be in the room. Get them into another room and talking about what hospital the patient may want to go (other info the paramedics/emts will need), or other conversation to keep them from getting in the way of them performing their tasks and assessments!

7. When a paramedic is asking questions OF THE PATIENT, please look at the paramedic and see if they are talking to you or not! Just because they are asking a question you know the answer too, or have already asked, doesn't mean they want it from you...it is an assessment tool for them (and us too guys!)...so let the patient answer! If the questions needs answering they will ask you..trust me!

8. Something hard to remember sometimes..but do ask the paramedics/emt's where they may be taking the patient! That helps when you notify MD's and Family! Sometimes hospitals are on divert, so that hospital you assume they are going to may not be available, so another must be chosen..or the paramedics may take them to a hospital more equipt to handle the case. Just something I learned by not asking..LOL!

9. They are professionals too, please give them credit for what they do by being professional and poliet.

10. And this one is for those with DNR's and POLSTS in hand, Paramedics/EMTs know what they are doing when it comes to DNR's/POLSTS better than nurses do, so don't get all touchy if you all the sudden see them put in an IV when it says no IV's! Most states have a grey area for 'short term' IV use, which is under 3 days...so the expertise of the paramedic can make the choice there! A hospiatal ER Physician can order it pulled if need be, must most times it is really needed for various things you may not have considered. I have had more nurses complicate matters over this..and even fire EMT's towards Paramedic...they know what they are doing so if you really feel the need, state your point and leave it alone! Best they do it then and there then having to cater to a Nurse or Family member and have to do it in a bouncing ambulance...trust me! (oh that is a real treat! Nothing like hitting a speed bump/sudden break in mid poke! LOL!).

OH yeah..and I rather liked my hubby's teaching about what it means to be a paramedic/emt to his student riders! "When is the ONLY time this patient will have 100% attention for 100% of the time by one medic? Yep, in our ambulance! So keep your eyes open for everything going on with this patient! What may be the chief complaint may be just the start, so best we get this information and relay it to the ED staff so the patient gets the best of care! Here we are, 1 foot away from this person for 15-30 minutes with our eyes only on them...and it will be the only time this will occur and a great time to learn and assess as much as we can! Even the nurses in ICU or CCU have more than one patient to have to watch...us..THIS ONE! Our info will help other medics to help this patient...keep those eyes and mind keen!"

I thought that was pretty cool!!!!!! :) Very positive and right advice!!!!!

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:o I think it is OK for LTC to send DNR patients to the hospital. DNR means no invasive stuff like putting in a new trach. DNR means no CPR. DNR does not mean "no care".If a patient is having respiratory distress perhaps they can be helped with breathing treatments and breathing meds. Most LTC's I have worked at have no respiratory therapist on duty.So maybe the hospital can help in this kind of situation. And yes it is a family's right to send them to the hospital even if they are a DNR. LTC centers are usually much more short staffed than hospitals. Who wants their loved ones spending their last days on earth dying and being ignored in a nursing home?. Why not let them spend their last days on earth in a hospital(not ICU or CCU) where they will usually get more attention and better care?
I beg your pardon. I hated sending my patients to the hospital from LTC because they often came back with decubes, confused, disoriented. it is very traumatic for them to be taken out of their environment, esoecially when they are ill to be around strangers who don't know all their littlquirks. DNR has nothing to do with putting in trachs, or giving ABT's. when a pt. is sent to the hospital for at least 3 days they then can get medicare which will cover IV ABt's and therapies. so unless they are on their death bed or have rquested not to be sent to the hospital, they go period.

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I just sent in a man who has been declining quickly from CHF over the past three months. He was unresponsive at lunch, even to mod/severe sternal rub and shouting at him in his ear. His heart was normal and strong at 82, resps at 18 with snoring, but just wouldn't respond! He has a DNR order and we know this mans heart is at the point that the heart just can't do this anymore (he has been sent in 3 times...good ol lasix time and time again and sent back...it isn't working folks!).

I HAD to make the choice to send him in, even though I knew...oh goodie..more IV lasix, fluid restriction, and back home. He was very independant three months ago and still has the mindset to be independant, but each time he goes into the ED..he is weaker, and has less ablilities...but the same mind that says "I can do things on my own!" It is very sad...I know if he comes home he will be even more limited, more miserable, and less in spirit than the last time...breaks my heart!

BUT I had to send him in...DNR's do not mean not to send someone to the ED if they have a pulse and breathing but are in trouble that you can't resolve! Unresponsiveness is a VERY valid reason to call 9-11 in, and you will get in serious trouble if you don't. Yes, sad choice, but the ONLY choice!

I expressed this to the paramedics..and a small history of what has been going on. Since I knew most of them, and was able to communicate well...they knew that I was suggesting to really follow the DNR and not do anything invasive if not necessary for their protocols (our DNR's still have grey areas...so it was basically..okay guys, no grey..lets go cut and dry please if we can!)! They got it, and agreed with me..heck, they saw the look in my face like "I have to, it is whats right..but guys....oh man this really hurts!". Thank goodness I communicate, work and respect them so much...it helps a great deal! :)

The patient all the sudden showed long runs of V-tach...okay. So off to the hospital code three. I know the paramedics will really honor the meaning of that POLST (our DNR orders), but the hospital...I have no idea! (along with the idea the last poster said about all the sudden they come back with tubes!!! It's like 'no invasive means' is missed! NO I am not blaming nurses..LOL! More like the old liablity and doc cycle.).

I am hopeful if he does come back that the family and MD will FINALLY get him on hospice care like I suggested till I was almost red in the face three months ago! That way we can provide comfort care and stop this cycle of ED, home, ED, home!

But I just thought it was very great to have such great teamwork with my local EMT's/paramedics...they listened because over the years I have shown them the utmost in respect...and it is paying off for my patients by providing excellent communication and respect between nurses and paramedics/EMT's :)

(not to mention we are in the middle of a huge ice storm...our poor EMS is going nuts today and folks are doing doubles with no breaks!!!! OUCH! So them listenening to me on top of a crazy day for them...awesome!!!!!).

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OK, first off we do not thrive on trauma calls, nor do we have an inferiority complex. We are plain tired of ariving at LTC facilities and having the nurses not provide ANY information on the patient, if they even bother to come down to the room themselves versus sending a CNA. When you call for an emergency ambulance, you should have ready, or someone other than yourself in the process of copying the patients MAR, recent H&P, and labs. Half the time we get to the facility and we are handed a slip of paper with insurance info, basic demographics, recieving facility name, and maybe a code status. Don't tell me that they just need transport and you already sent the info to the hospital via fax. Also, don't seal the envelope that you give to me with the info and tell me I can't read it, I'll just open it in front of you. Also (I know I ranting but sorry) someone gaining 20# over the past week, with NO acute SOB is NOT an emergency, don't call 911, either increase their diuretic, or call a commercial agency for a non emergency transport.

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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.

:madface: Excuse me, no the hiarchy order is NOT RN, Paramedic, EMT. Once you call me to the scene, the hiarchy is patient, on-line med control, Paramedic, EMT, and LTC nurses on the bottom. We do NOT provide temporizing care, Paramedics provide definative care. When you forget to round on your diabetic patient and find them unresponsive, we are the ones who wake them up. We are the safety net for our contries health care system. As far as bragging, it's called having pride in our work. I can't tell you the last time I heard a bunch of LTC nurses sitting around talking about the big enema they gave just the other day. Finally for the funding issue, guess what, we are suffering from the same lack of reimbursement that you are. Most basic EMT's earn less by working on the ambulance than by reciting the phrase "would you like fries with that?". But they do it anyway, they have pride in what they do. Also remember as you stated, you have mostly volunteer responses. What other health care profession is there where people have a full time job, families, and still find the time to go to school for EMS and volunteer to take calls.

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Agnus expounds: FYI the hiarcheal order is RN then Paramedic then EMT.

Me: And FYI "hiarcheal" is usually written as hierarchical. Also, there are some who would argue the order should be MD--->God--->Midlevel practitioners (PA/NP/CRNA)--->RN---->LPN---->CNA.

There are also other branches from above God where you have Firefighters and everyone else below them. Another branch starts above God where you have Police Officers and, of course, everyone else below them (the Police and Firefighter brances are often in mortal combat for the elusive taxpayer dollar and have to align their forces in conjunction with political candidates who, of course, are above God but under the Devil.

Branches usually do not intersect as you have suggested. This may occur on a forum, such as this, when the debate over who should work in an ER (paramedic vs RN) and who should be the supervisor of the other's actions, but these are only "pseudo-branches" as they are often just the cogitations of "internet experts" who like to tell stories about their first hand experiences in dealing with the other brances. Thus, the RN vs paramedic battle is usually fought in the small minds of those who often have never worked both jobs, yet think they know all about the other because they spent a few hours in a firehouse or an ER.

Your command of grammar and spelling is a challenge and I had difficulty trying to grasp your somewhat rambling ruminations.

As an RN I'm not impressed with your hypothetical argument of emergency care being "one narrow focus," since emergency medical conditions can be very broad based. Perhaps what you meant was the focus of the paramedics training is on the initial identification of life-threatening conditions and their treatment with stabilization until delivery to an Emergency Dept. You can argue that "definitive" care starts in the hospital, but if all you get are dead bodies...well...might as well call yourself the morgue.

As a paramedic, I'm very impressed with how poorly you make your argument which rings of jealousy from not being able to ride around in the big red trucks with the lights and sirens on. Listen, if you want I'll help you get your paramedic certificate and then you too can join us at the firehouse for a little BS session as we kick back in the La-Z-Boy recliners and eat ice cream...but don't think for a second you get to hold the remote control...

All I have to say is AMEN.

oh and, if you're in my firehouse, it's my remote control!! hahaha

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Agnus expounds: FYI the hiarcheal order is RN then Paramedic then EMT.

Me: And FYI "hiarcheal" is usually written as hierarchical. Also, there are some who would argue the order should be MD--->God--->Midlevel practitioners (PA/NP/CRNA)--->RN---->LPN---->CNA.

There are also other branches from above God where you have Firefighters and everyone else below them. Another branch starts above God where you have Police Officers and, of course, everyone else below them (the Police and Firefighter brances are often in mortal combat for the elusive taxpayer dollar and have to align their forces in conjunction with political candidates who, of course, are above God but under the Devil.

Branches usually do not intersect as you have suggested. This may occur on a forum, such as this, when the debate over who should work in an ER (paramedic vs RN) and who should be the supervisor of the other's actions, but these are only "pseudo-branches" as they are often just the cogitations of "internet experts" who like to tell stories about their first hand experiences in dealing with the other brances. Thus, the RN vs paramedic battle is usually fought in the small minds of those who often have never worked both jobs, yet think they know all about the other because they spent a few hours in a firehouse or an ER.

Your command of grammar and spelling is a challenge and I had difficulty trying to grasp your somewhat rambling ruminations.

As an RN I'm not impressed with your hypothetical argument of emergency care being "one narrow focus," since emergency medical conditions can be very broad based. Perhaps what you meant was the focus of the paramedics training is on the initial identification of life-threatening conditions and their treatment with stabilization until delivery to an Emergency Dept. You can argue that "definitive" care starts in the hospital, but if all you get are dead bodies...well...might as well call yourself the morgue.

As a paramedic, I'm very impressed with how poorly you make your argument which rings of jealousy from not being able to ride around in the big red trucks with the lights and sirens on. Listen, if you want I'll help you get your paramedic certificate and then you too can join us at the firehouse for a little BS session as we kick back in the La-Z-Boy recliners and eat ice cream...but don't think for a second you get to hold the remote control...

WELL PUT!

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I can honestly say that in my years of nursing, NO ONE has treated me with less respect than the EMT's. In HHC, LTC, and in my current clinic environment! Nor in my personal experience, as 2 EMT's came to my home in answer to my EMS call d/t my husband having an MI, asked me what kind of nurse I was, rolled their eyes and proceded to do everything in thier power to disprove my diagnosis. I was right, thier ineptness and grandious attitude was the number one contributing factor to my husband losing 30% of his heart muscle d/t lack of treatment. Problem was, they followed him into the ER and did the care at the ER too! It took me SIX HOURS before someone finally believed me and started his treatment.

I have more stories too, like the HHC COPD patient gone bad, I called, got the attidtude, as usual, they took him only on my insistance, patient died within 24 hours.

Or how bout the kid in my clinic with a BS of 17, they stuck thier head in the door, from 5 feet away, took one look at the kid, and said, you have it under control, he is fine, and WALKED out on me!!! Mind you, I'm in a clinic all alone. No back up, no emergency equipment or medication. EMS is my ONLY backup.

I reported those cases to the head of the dept. They were reprimanded. After my hubby, an entire cardiac program was revised for EMS. I am currently on a first name basis with the dirctor of our large county EMS program, I am continually asking him to help improve the knowledge of EMT's about Nurses and our function. Over the years since I started this fight, in 1995, things have gotten better, but it is a continious fight for respect.

And, yes I agree, the classes that the EMT's took, both prereq and req's are not on the level of the nurses. The nursing requirements are much stricter and of higher levels. PERIOD.

I can only sumise that saving lives and picking up people off the pavement, skews the EMT's perception as to who they are.

OK, EMT's flame me at will but what i have said is the truth of the matter.

The bottom line...there are good nurses and paramedics, and there are bad nurses and paramedics. You have good days and bad days, we have good days and bad days. We must ALL remember what comes first, and that's the patient. It's not about "my stethescope is bigger than yours". Look at it this way, would you nurses treat a MD the same as you treat your EMS crews. EMS, would you treat the LTC nurses the same as you would the ER RN's or your medical director?

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Excuse me, no the hiarchy order is NOT RN, Paramedic, EMT. Once you call me to the scene, the hiarchy is patient, on-line med control, Paramedic, EMT, and LTC nurses on the bottom.

When a paramedic is on scene, I AM STILL IN CHARGE till I TRANSFER CARE (either by report or saying so) care over to the paramedic! NOW, seeing as I am married to a paramedic and one of the most paramedic friendly nurse I know...I rarely have probelm with it at all (some fire paras yes...but mine have larger chips than usual...LOL, even my hubby complains about certain ones, but alas..they get the same respect from me as anyone else..which is high..they just don't return the favor..that is obvious, I am the devil as far as they are concerned..LOL!)!

But I see it this way...(and yes I work LTC!), I called paramedics for their equipment and knowledge/experience in these situations to assist the patient...so I depend on their expertice in order to help my patient, but their expertice doesn't outweigh my responsiblity or ability to help as well (because I am the highest ranked in MY protocols/procedures unless an MD is present...kinda a clash there in disaplines between the EMS and RN...hey, I didn't write the stuff..just have to go by it..LOL!).

I don't butt in unless I am asked because I feel that I may delay treatment, but I am sure as heck there, and luckily more trained than most in prehosp and emergency care! We are a team, I respect my team, I work with my team, no fussing over who has a license vs certification, or even who has more education/experience...there is no time for that...just 'okay you are an EMT or EMT-P...okay lets do this crazy thing :)...

I trust my team, and that includes paramedics...and of all of my team members..a paramedic has never let me or a patient down (which I can not say of other nurses or Doctors for that matter!).

NOW, as far as your protocols...who do you report to when you must transfer care??? "A nurse or Doctor or equivalent",(which I still don't understand what the equivalent is...but it is in our protocols so...eh). So tends to reason that nurses are indeed NOT at the bottom of chain of command in emergency scenes...but somewhere in the grey on the side..and believe me, I seem to be placed there a lot despite my very obvious respect and known ability to assist as needed (why the heck do you think a nurse would take ACLS and CME in pre hosp emergencies when you work LTC...because I work with paramedics and depend on them...feel it only just to be able to help if needed..that means...got to know something of what they do!).

When care is transfered...you bet...that chain of command as you say, but any good paramedic knows that listening to a nurse is a pretty good thing to do as long as it doesn't hinder care. Nurses will have info to help you to understand pre existing conditions, recent probelms, and most if not all the questions you ask a patient (but we know the facts, and most often those facts are not remembered at the time by the patient). And with all the new ACLS and new protocol guidelines now..having to think of more 'underlying causations' and what not...I was shocked...I was in ACLS class saying ...shoot, then they have to be nurses too...geesh give them a heck of a lot more money folks..that is tough!

BUT lord in heaven I know those 'nurses' or even caregivers or 'docs' that try to run the scene or even try to barge in and start being Mr. or Mrs. big shot (and not reserved totally for emergencies..happens all the time). Seen it SO much on ride alongs and on scene. That is why I made sure the paramedics and fire know me, and I wait at a safe distance for any assistance as needed by their que... Makes me feel like an idiot sometimes...just standing there...but it is best and my feelings do not ever outweigh my patients health. So I stand their and wait for assistance PRN (although okay, most times I have their equipment out of the bag just as they call for it to hand to someone so they don't have to walk around furnature to get it..LOL...they all the sudden call for it and boom...there it is that very second and me with a big grin.."hey, I know your bags!").

We must work as a team...none of this "I am better than you" crud that only hinders care and created hard feelings! That patient doesn't care who you are, just as long as you can help...and that is the focus :) the patient!

But may nurses also remember, once transfer of care is given the EMT/EMT-P are held very responsible just like us for anything they do...so don't start getting in there and doing things without their consent! Seen some nurses do this, and oh boy does the stuff hit the fan...delay care...and just not cool at all...

Oh, and I find saying "I don't know" to make me feel horrible when paramedics ask me a question...I like to say "it is unclear in the chart"...that helps when you don' t have the info, like MOST LTC's...and doesn't make you feel like you are seen as a goonball..LOL! Just a little hint I picked up...

Funny story on top of a very long post..LOL! My hubby, a Doc and I were chit chatting at a function and we were jokind about how we always sign check or other things outside of work with our rank initials....and my hubby pipped up "hey...I have more..EMT-P...does that mean I win???". It was funny as heck! Then the doc pipped up "no, it just means you need more letters to remember just like your protocols....how fun for you..." LOL!!!!!

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The bottom line...there are good nurses and paramedics, and there are bad nurses and paramedics. You have good days and bad days, we have good days and bad days. We must ALL remember what comes first, and that's the patient. It's not about "my stethescope is bigger than yours". Look at it this way, would you nurses treat a MD the same as you treat your EMS crews. EMS, would you treat the LTC nurses the same as you would the ER RN's or your medical director?

Very well said. I have dealt with both both RN's and Paramedics that I would not want taking care of me or my family and I have dealt with RN's and Paramedics that I would trust with my life in their hands. We need to all learn to work together and stop talking about whose job is harder. We all have a hard job and I give EMS a lot of respect, because I don't think I could do their job. And because I respect EMS, they respect me when they bring me patients in the ER. None of us are superior to one another. We all have a different job. So, EMS does a wonderful job. Keep up the good work.

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I think this will be a war that will never end, just as LPN/RN, ASN/BSN, etc. There are good nurses and good paramedics. I myself haven't had many problems from EMT's, but I have all my paperwork copied, know a (somewhat, if from another hall) hx of pt. move dressers. w/c etc. out of way and help with transfer. Most of the time I get a thank you and I'm treated with respect. Of course you have your jerks out there too. One night my house supervisor was told that sending this man out was a waste of taxpayer's money, with his wife and him present. On the other hand, while performing a code, I had a fellow nurse tell the paramedic, she knew what he was doing because she had seen it on ER. I about flipped. My respons was we aren't all that stupid. No wonder they think we're retarted when someone makes such a stupid comment. Another thing to consider is, if we call an on call Dr. the majority of the time that is their all time fix, send to ER. You literally have to fight tooth and nail to have something simple treated at facility. There are many times I have sent someone to ER that I didn't feel they needed to go, but family or MD ordered. I usually just apologize to paramedics and explain the situation. I almost always have the understanding and sometimes sympathy. If I have one come in all cocky, usually by the time they have left, their attitude has changed, as I have all my info ready, follow to res room and assist as needed. They are trained for emergency situations way more than I am, I tell them to let me know how I can best assist them without getting in their way. If I was dealing with something going on the floor, I am more trained and expect them to stay out of my way!!!!! There are idiots all over in every profession, unfortunately, and we just have to deal with them in the most professional way we can. Sorry for the rant and any typo's I was on a roll for a minute :rotfl:

One more point, If I feel I need to send a res out and the paramedics want to tx me like sh**, then that's ok too. I'm doing what I think is best for my res. They also have a lot more equipment then I do in LTC and can get results back a lot sooner. :)

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