Things LTC Nurses wish EMTs and Paramedics would understand.

[downsouthlaff, LPN]

The long lived what seems to be country wide rivalry between EMTs and Long Tern Care Nurses is an obvious one. Long into social media, you see EMT pages posting ridiculing memes about long term care facilities and the pooor nursing care provided. Visit and EMS forum, and you'll see threads doing the same.

As a former EMT, now LTC Nurse, I've come up with a list things that I do believe every LTC Nurse wished EMTs understood.

1. There's a big difference in quality of care when patient ratios are 2:1 rather than 1:40 plus. When an LTC Nurse doesn't know the answer to a question off the top of his/her head, doesn't know the events leading up to the emergency, I doesn't mean that they are lazy or incompetent, when you have 40 demanding residents, to give medications too, and loads of charting and other work to do, as a charge nurse, you will not know every detail about every resident every minute of the shift. Imagine getting to the hospital to give report on 1 patient and having 40 patients in the back of your ambulance.

2. We don't make the rules. Sometimes as EMTs you may think that just because a patient fell and has no S/S of head injury that the transport isn't necessary, but a doctors order is a doctors order. If a residents primary care physician orders an ER eval, then that's fina. There's nothing you can say that's gonna change the fact that my resident is going to the hospital. As a licensed nurse, I will not be standing in front of my state board at a hearing, having to explain why i refused to carry out a physicians order. I once told an EMT who was being difficult and causing a scene in the hallway, asking why we were sending a resident out for such a small not in his head, in such stormy conditions outside, " Because I'm not putting my license on the line by tellling Dr. Brown (not real name) that I am not sending his patient to the hospital, but you are more than welcome to do so,".

EMTs and Nurses play a very vital but very different part of healthcare today. And I do think that if we could be a little more understanding of each other's roles, responsibilities, obligations, and limitations, the ride for the resident from the LTC Facilty to the local ED may be a little less rocky.

[applesxoranges, BSN, RN]

In my area, a lot of places call private ambulances which mean that usually the nurse has called the doctor and the doctor said send them. Rarely do they call 911. It would be nice at this point that they could give some general version of events. 99% of nurses can because like I said, it takes time for them to call the doctor, then call the private ambulance company, get the chart together, call the hospital, and then we get there and they can give us some version of events.

Now, I have seen in sketchy nursing homes where no one can tell us anything. Mainly sketchy nursing home company A. I can recall several episodes like we walked in and asked a nurse where the patient that needs to go to the ER is. The nurse said "No one tells me anything" and walked away. We managed to find the patient in the room and that same nurse walks in. Um... it's your patient? Another time in the same nursing home, they gave us the paper that said "DNR." I was going through the paper work and asked where the DNR copy was. She said "right here" and pointed to the piece of paper that said DNR. It was their cheat sheet that was used to tell them whether the patient was a full code or a DNR. It took her getting the chart and us showing us her what the actual DNR paperwork was.

On the flip side, a medic wanted a nursing home nurse written up for giving a med that wouldn't have worked. We chilled him out because I told him that she had to have had an order to give that med in the first place.

[TheCommuter, BSN, RN]

I wrote about the unspoken rift between EMS and LTC nursing staff nearly 10 years ago. The thread received more than 100 responses. The phenomenon is real.

https://allnurses.com/geriatric-nurses-ltc/rudeness-from-emts-268561.html

[sallyrnrrt, ADN, RN]

The long lived what seems to be country wide rivalry between EMTs and Long Tern Care Nurses is an obvious one. Long into social media, you see EMT pages posting ridiculing memes about long term care facilities and the pooor nursing care provided. Visit and EMS forum, and you'll see threads doing the same.

As a former EMT, now LTC Nurse, I've come up with a list things that I do believe every LTC Nurse wished EMTs understood.

1. There's a big difference in quality of care when patient ratios are 2:1 rather than 1:40 plus. When an LTC Nurse doesn't know the answer to a question off the top of his/her head, doesn't know the events leading up to the emergency, I doesn't mean that they are lazy or incompetent, when you have 40 demanding residents, to give medications too, and loads of charting and other work to do, as a charge nurse, you will not know every detail about every resident every minute of the shift. Imagine getting to the hospital to give report on 1 patient and having 40 patients in the back of your ambulance.

2. We don't make the rules. Sometimes as EMTs you may think that just because a patient fell and has no S/S of head injury that the transport isn't necessary, but a doctors order is a doctors order. If a residents primary care physician orders an ER eval, then that's fina. There's nothing you can say that's gonna change the fact that my resident is going to the hospital. As a licensed nurse, I will not be standing in front of my state board at a hearing, having to explain why i refused to carry out a physicians order. I once told an EMT who was being difficult and causing a scene in the hallway, asking why we were sending a resident out for such a small not in his head, in such stormy conditions outside, " Because I'm not putting my license on the line by tellling Dr. Brown (not real name) that I am not sending his patient to the hospital, but you are more than welcome to do so,".

EMTs and Nurses play a very vital but very different part of healthcare today. And I do think that if we could be a little more understanding of each other's roles, responsibilities, obligations, and limitations, the ride for the resident from the LTC Facilty to the local ED may be a little less rocky.

oh, downspouthlaff...... you knocked this post out of the park, amen amen

You so are on target

and as a seasoned acute care and LTC RN, the problem, is lack of knowledge, in the culture and "real world goings on" in our various work environments.....

even as frustrating, needing and wanting to practice in certain situations in LTC, as I would in an ER

Bless You

[heinz57]

Unfortunately, many times the ER nurses will add fuel to the fire by siding with the EMTs and Paramedics by throwing LTC nurses under the bus and going "all BS and laziness" instead of acknowledging different protocols and workloads. Nurses can be their own enemies and drag those less knowledgeable about certain patient situations into the mix which increases the divide.

[sallyrnrrt, ADN, RN]

Unless one truly had walked and worked in same shoes...... A misunderstanding may occur, however, I do understand and have walked in both shoes.......I expect higher acuity nurses, and ems, to understand by now.........

[RiskManager]

I do risk management consulting for our County EMS division, and the big issue up here now is LTC calling 911 to pick up a patient who has fallen. This is not necessarily due to any injuries sustained by the patient or that the patient needs transport to the ED, but rather so that LTC staff does not sustain any injuries by lifting the patient.

[VivaLasViejas, ASN, RN]

There are several bones of contention that I used to have with EMS when I was an LTC nurse:

1) I don't CARE what the resident's insurance is. It's not like the responders themselves aren't going to get paid if they transport someone who's on Medicare or Medicaid. If the resident needs to go to the hospital, they're going.

2) DNR DOES NOT MEAN do not treat. 'Nuff said.

3) Don't look down on me as if I don't know anything just because I am an LTC nurse. By the time EMTs arrive, I've done an assessment, a set of vitals, a neuro check (if appropriate), and I have the chart and transport papers ready to go. If by chance I don't have those things together, it's because my resident is in severe distress to the point where I can't leave him/her.

There. I feel better now.

[heinz57]

I do risk management consulting for our County EMS division, and the big issue up here now is LTC calling 911 to pick up a patient who has fallen. This is not necessarily due to any injuries sustained by the patient or that the patient needs transport to the ED, but rather so that LTC staff does not sustain any injuries by lifting the patient.

In all fairness, at many 911 scenes there are at least 3 EMS trucks including Rescue, ambulance and fIre giving about 8 - 12 personnel to help the 22 y/o female with a hand injury to the ambulance. In a nursing home the staffing might be 1 nurse and 1 CNA to 40 patients. The other 39 patients can not be ignored. This is a difficult concept for many in EMS to understand when they have just one patient. If they have more than one, they call for back up which brings another 1 to 3 trucks with 2 to 8 more EMTs or Paramedics and maybe a few volunteers for a second patient.

[TheCommuter, BSN, RN]

I do risk management consulting for our County EMS division, and the big issue up here now is LTC calling 911 to pick up a patient who has fallen. This is not necessarily due to any injuries sustained by the patient or that the patient needs transport to the ED, but rather so that LTC staff does not sustain any injuries by lifting the patient.

I worked as a LTC nurse for six years. Here are a few reasons why we'd call 911 to help get up a nursing home resident who has fallen.

1. The nursing home population is increasingly younger and more obese than ever. Several years ago, a 560-pound man fell while ambulating to the bathroom. The four nursing staff members in the facility (1 nursing supervisor, 1 floor nurse and 2 CNAs) all sustained injuries while attempting to help this resident back up.

They ultimately called 911 after unsuccessfully attempting to lift this man. It took seven fire/rescue staff nearly one hour to safely get this nursing home resident up and off the floor. The LTC facility's Hoyer lifts had a 450-pound weight limit.

2. Some corporate-owned nursing homes have stringent no-lift policies that forbid staff from lifting residents off the floor after falls. If nursing staff wants to stay employed, they must call 911 and wait for EMS to assist the resident up after a fall.

I know, I know...this policy seems really wasteful. However, do not hate the players of the game (read: the LTC nursing staff). Look more closely at the corporate idiots who created the game (read: formulate foolish rules).

[RiskManager]

^^^You are spot on: we are told this is a corporate requirement to call 911. We are trying to work with the corporate office but with little success so far.

[Elladora]

2) DNR DOES NOT MEAN do not treat. 'Nuff said.

Had an ER nurse call our facility and ask, "Why did you send him? He's a DNR." I literally had to count to ten before I could answer her.