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.
I can't believe some LTC facilities have a 'do not lift a resident if they've fallen' policy. I've hurt myself a few times, as have numerous others where I work. My CNA's - no matter how good/bad they are in any other way - deserve more pay & support simply because of the lifting they do, although we do have Hoyers for the heaviest residents.
On EMT's: for the most part, I get along fine with them when I send someone out, but yeah, I've had a few who were condescending. The worst that I remember was when I sending a guy out w/multiple problems, including low O2, and knowing that the EMT's had their own O2 in the ambulance, I'd just disconnected the resident from his O2 concentrator before they walked into the room. One EMT didn't even think I'd checked the resident's O2, and then when I told him what the % was, he said 'well this machine isn't even on', and it was all I could do not to say "Do you REALLY think I'm that stupid?!?".
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
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.
Yes, you hit the nail on the head.
A few years ago I telephoned a local hospital ED to give report regarding a patient we were sending for respiratory distress. The ER nurse's tone was condescending during much of the conversation.
She asked, "Which wrist is the IV line in?"
I said, "I do not know."
She snapped, "So you're the nurse and you don't know where the IV is?"
I replied, "No, I am the house supervisor, not the patient's primary nurse. No, I do not know where the IV is. By the way, I am the one giving report because you people and the EMS crew have reputations for being so mean to our nurses."
Her tone became less snappish after I said this. Hence, I imagine she had a mockery field day with the EMS crew who transported the patient. To be fair, perhaps I should have known where the IV site was located, but one cannot know everything when overseeing a floor of 40+ patients without providing their direct care.
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.
^^ THIS.
I wish AN had the little heart to 'love' a post, like on Facebook. Well said.
A few years ago I telephoned a local hospital ED to give report regarding a patient we were sending for respiratory distress. The ER nurse's tone was condescending during much of the conversation.
She asked, "Which wrist is the IV line in?"
I said, "I do not know."
She snapped, "So you're the nurse and you don't know where the IV is?"
I replied, "No, I am the house supervisor, not the patient's primary nurse. No, I do not know where the IV is. By the way, I am the one giving report because you people and the EMS crew have reputations for being so mean to our nurses."
Her tone became less snappish after I said this. Hence, I imagine she had a mockery field day with the EMS crew who transported the patient. To be fair, perhaps I should have known where the IV site was located, but one cannot know everything when overseeing a floor of 40+ patients without providing their direct care.
It's this kind of crap that absolutely disgusts me. LTC nurses provide very important care to their patients therefore, it makes me so angry to hear them being disrespected by other nurses and EMS. I work in a telemetry unit at a hospital and the last thing I'd do is be condescending and mean to a fellow nurse. LTC nurses do what I am not even close to capable.
I have worked in both nursing and EMS. i truly believe the real source of the rudeness is jealousy. Doing the work of a paramedic for 15$/hr gives you a real complex when you know the majority of nurses, some that are half your age, are making double and triple what you are. Every medic/basic gone nurse i know (including myself) gains a whole new respect for nurses once they actually become one.
Specializes in Healthcare risk management and liability.
^^^I wonder how many true paramedics are making $ 15/hour. Here in the greater Seattle area, an actual paramedic (EMT-P) working for a fire service is averaging $ 60,000 and if you work for Seattle, Bellevue, or Tacoma Fire, you are making more than that. Pretty much all firefighters in this area are trained to the EMT level, and firefighter salaries are much more than $ 15/hour in a paid municipal department. An EMT working for a private ambulance company is paid peanuts, but they are not a paramedic. Even in healthcare, many people conflate the two.
My time in LTC was very brief (less than one year). Prior to it I had worked many years in a hospital setting. The change in the attitude was so obvious that I found it offensive.
One evening I had a resident that had fallen and reported hitting her head. We were an ALF and some of our residents were completely A&Ox4 so they had the right to refuse medical care even if policy was to send them out (obviously we cannot force them). So I assessed the resident and noticed that she was not herself. She had a history of Cardiac issues (that I won't get into) and had new onset slowed and slightly slurred speech as well as a new slower and unsteady gait, particularly on one side. My past experience made me think possible CVA/TIA and spent 15 minute studying urging her to seek medical care. She wanted her husband to come to the room first (was at dinner). I spent another 5 minutes convincing him and then the EMTs showed up. Some can maybe guess what happened next.
EMT: "Honey, do you want to go to the hospital?"
Resident: "No"
Me: "You reported to me that you had fallen and hit your head. Your speech is slurred and slower than usual. Your walking is also slower and unsteady, and you don't normally lean to your side. If it's nothing, you'll be back here tonight. If it's something, waiting could result in irreversible injury or death"
Resident husband: "Can she wait and see the doctor in the morning?"
EMT: "I don't see why not"
Me: Ready to have a coronary as the ambulance is turn away and they leave. I then called they daughter, explained the situation, and put her on the phone with the woman. She agrees to go but the husband is now mad. "But the young doctor fellow said it could wait". Me, irritated beyond belief finally hit a breaking point and said something that I would never do. "HE is not a doctor. HE is an EMT. I am a NURSE and have known your wife for MONTHS, not MINUTES, and something is very WRONG right now". He wasn't happy but they agreed to have the ambulance come back.
Hours later he returned alone and thanked me. She needed medical attention ASAP.
I know most EMTs are great and I appreciate you. But when we call you because we believe our residents are in trouble, please don't help them change their mind about receiving treatment, especially in an ALF where we do not offer skilled nursing care. At that particular facility, there was no nurse on duty after 11pm. I'm affraid what may have happened if they waited longer.
A few years ago I telephoned a local hospital ED to give report regarding a patient we were sending for respiratory distress. The ER nurse's tone was condescending during much of the conversation.
She asked, "Which wrist is the IV line in?"
I said, "I do not know."
She snapped, "So you're the nurse and you don't know where the IV is?"
I replied, "No, I am the house supervisor, not the patient's primary nurse. No, I do not know where the IV is. By the way, I am the one giving report because you people and the EMS crew have reputations for being so mean to our nurses."
Her tone became less snappish after I said this. Hence, I imagine she had a mockery field day with the EMS crew who transported the patient. To be fair, perhaps I should have known where the IV site was located, but one cannot know everything when overseeing a floor of 40+ patients without providing their direct care.
What did it matter what wrist the IV is located in? It's picky crap like that that irritates me. As a floor nurse I don't ask the ED nurse that- I'll look in the chart or find it when I assess the patient after they get to my floor. In my opinion report is for more important things.
I'm just plain tired of superiority complexes- floor vs ICU, acute care vs LTC, BSN vs ADN, RN vs LPN, etc.- what difference does it make? We all want what is best for our patients. End of story. I had a frustrating experience over the weekend transferring a patient to a higher level of care due to a nurse with a superiority complex, so sorry if I got a bit off topic.
As a former EMT and current ER Nurse, I respect no other specialty more than LTC nurses. I can't think of a more demanding nursing position than a LTC nurse. Perhaps I am in the minority here, but having transported Pt's from LTC facilities as an EMT, and now receiving them in the ER as a RN, I can only imagine what a shift is like for you guys.
It's extremely difficult to work together from A to Z, and with the elderly that are chronically ill with frequent re-admits to the hospital, it is very easy to lose an important piece of information that may save his or her life. Is the Pt on blood thinners? When was the last well known neuro check? Does the Pt have a DNR? Are the vital signs stable? Stuff like this is critical to know. Yes the Pt may be a frequent flier, but this information must never be taken for granted just because they have been to the hospital 8 times in the past month. We tend to see a complete lack of communication between LTC facilities and EMS because of this. Just last night, I had a pt come in for a routine fall eval with no cardiac history get admitted to tele for newly diagnosed rapid a-fib at 95 years old. The EMT's never reported the Pt had a HR irregular and tachy. A few days days ago, we had a Pt come in having a massive MI where ALCS was never dispatched because BLS treated it as routine. There are other instances when we receive a Pt from LTC with basically no history from EMTs because they were unable to obtain report.
I have been in LTC for many years and it has been ages since I had difficulty with the local EMS. We utilize private company for most transports but if they are busy or we need help stat then we call 911 and we have help within 5 minutes.
When I hear a coworker complain about the EMS, I have to ask a few questions first. Many times, it is our (nurses) fault. Yes, I am willing to take the blame or at least put it on my coworkers. When we decide to send a resident out, unless it is an extreme emergency, then we should have a complete or at least focused assessment including baseline for that resident, I would expect a clear path has been made and if there is time, basic paperwork and having the resident cleaned up if needed. Greet the emt/ medic and give them a brief report...not just point the way.
We are not "stupid or lazy" but sometimes things get crazy. I work part time so I might not know complete histories, but I am willing to share assessment and reason for transport and every bit of information I do know. Sending a resident out for AMS and not checking vitals, O2 sats or a finger stick on a diabetic???? Yeah, If I was EMS, I would be pissed.
Sometimes they might be upset that we didn't call sooner. Often times, it isn't our fault. Resident might have refused (well documented) or maybe the condition changed quickly or maybe I just walked into this mess.
She snapped, "So you're the nurse and you don't know where the IV is?"
No, it REALLY DOESN'T MATTER where the IV is! This is one of the most stupid questions/ report items I have ever heard in my decades of nursing. Is it patent? That really is all that is needed. Even gauge is being a little anal retentive.
djh123
1,101 Posts
I can't believe some LTC facilities have a 'do not lift a resident if they've fallen' policy. I've hurt myself a few times, as have numerous others where I work. My CNA's - no matter how good/bad they are in any other way - deserve more pay & support simply because of the lifting they do, although we do have Hoyers for the heaviest residents.
On EMT's: for the most part, I get along fine with them when I send someone out, but yeah, I've had a few who were condescending. The worst that I remember was when I sending a guy out w/multiple problems, including low O2, and knowing that the EMT's had their own O2 in the ambulance, I'd just disconnected the resident from his O2 concentrator before they walked into the room. One EMT didn't even think I'd checked the resident's O2, and then when I told him what the % was, he said 'well this machine isn't even on', and it was all I could do not to say "Do you REALLY think I'm that stupid?!?".