Working with EMTs vs CNAs/techs

llltapp · Feb 2, 2010

Paramedics and EMT's are just like most other ER staff, they have strong personalities. CNA's are naturally used to "reporting" to an RN. EMT's and paramedics are used to autonomy in the "field." They have a lot more knowledge and skill (in most instances) than the work they are doing in the ER so they sometimes get attitude at what they see as "degrading" tasks. After all, paramedics are trained in ACLS, PALS, they do intubations etc. in the "field."

The way I have dealt with this issue, be blunt, take them aside (you can't do this in front of all their buddies) and tell them that when you ask them to do something they need to either do it or tell you why they cannot do it. Nothing more, nothing less. If they have a problem with this, tell them you can discuss it together with your clinical director. THEN, walk away. Their response to this straight forward fact is irrelevant. You do not want to get into a pissing contest.

Editorial Team / Moderator · Feb 2, 2010

Personally, I had an excellent working relationship with my RN coworkers when I was a tech, and I was (and still am) a paramedic. We developed a mutual respect for each others' skills and knowledge. It probably helps that many of my RN coworkers are also medics, and know what the medic education entails. I think maybe the RN-tech relationship can be more collaborative, if you see what I mean, vs. superior and subordinate. But on the inside of those ED doors, unless the paramedic is working as a paramedic in the ED with an expanded scope beyond tech, the RNs can and should be able to delegate appropriate tasks, period, without hesitation.

llltapp · Feb 2, 2010

Forgot to mention, the fact that you have been a CNA is a great thing. With paramedics/EMT's I have found that in order to gain their respect (which is a MUST if they are going to work with and for you), you must respect them as well. Acknowledge their critical thinking skills, value their input, ask them questions you may have as well as fellow nurses. If they get the "buy in" they deserve, it becomes a team and not just "nurses vs medics/techs."

Lets face it, many times paramedics DO have more knowledge about emergency medicine than new nurses in the ED do. If you remain humble yet assertive in the knowledg and skill you do have, the transition will be easier.

It's a hard row to hoe, but keep your chin up and don't let people walk all over you :)

phoenixfire · Feb 2, 2010

Just to give a little backgroud, before I switched to nursing, I was in the military for several years, and I almost always got put on an all male crew. It always started out the same...I had to work twice as hard, and be twice as good as they were for them to respect me. But at the same time, I didn't take any crap from them. It takes time to build a working relationship with anyone, male or female, and you have to be the endurance runner and not the sprinter when it comes to building that relationship. With some men, all you have to do is ask, and with others, you have to bolster their ego. Its almost like dating without dinner and a movie sometimes. For me, the key to working well with men was to be one of them. Some women tend to want to be friendly with a man the same way they would with a woman, which is not likely to work well. Men are (often) straightforward, problem solvers, anlalytical thinkers. They want to be presented with a problem that they can fix. Mind you, this is just my experience, and does not apply to all men, so please don't flame me.

In your situation, I think that maybe they are looking at you as an outsider, and until you build that working relationship with them, it will continue. For me what worked was offering to help them, "Hey if you can start this IV for me, I can take care of that blood over there..." etc. It sounds like you are willing to roll up your sleeves, so it shouldn't be a problem. The other poster mentioned taking them aside and having that little converstation will work well to. Good luck.

Virgo_RN, BSN, RN · Feb 2, 2010

Most of our "techs" are EMTs. As others have mentioned, these folks are highly trained and used to a certain amount of autonomy in the field. I treat them as my equals, and defer to their greater knowledge base in certain areas. For instance, these folks are good at starting large bore IVs in dehydrated little old ladies with no veins in the back of an ambulance while it's bouncing down the road. They know their ACLS. Our techs get paid to start IVs, draw labs, transport patients, and clean rooms. They are also supposed to help with things like toileting, but many of them are often suddenly "unavailable" when the need arises.

As with any co-worker, work ethic varies from person to person. There are some techs that, when they are assigned to my hall, I breathe a sigh of relief, knowing that I have help. Others, not so much.

If you do need to correct a behavior, you need to pull them aside and speak to them respectfully. Public humiliation or talking down to them will only earn you their utmost disdain.

Da_Milk_of_Amnesia, MSN · Feb 2, 2010

I agree with the respect issue. I've been an EMT for like 9 years now. We get blown off by RNs all the time esp when im trying to give report. It's almost like they don't care what we have to tell them. It's as almost if all I am is damn taxi to bring patients there and back and that's it. Then when we find something out of the normal and tell a nurse about it during report they either don't believe us, or insult or intelligence by checking (as we are telling them) what we found. I had a guy with pneumonia and he had rales on one side and not the other. It was clear rales, couldn't miss em. Well I get to the ED and I'm giving report...xx Y/O c/o SOB times X amount of days, Spo2 is _ on _ and lungs have rales on the right and whatever on the left. As I'm telling her this she goes to check his lung sounds. I said to her what you didn't believe me or didn't think I know what I was talking about? She said no I just had to check for myself. I said rightyfully so, but the least you could do is listen to me first and then do your assessment instead of blowing me off. I found her at the RN station and I flipped around my badge and I said just so you know I'm not a moron as you might have thought and I actually do know what I'm talking about.

In short treat us as we are all on the same team, listen to our reports and don't insult our intelligence. Help make our lives easy and we'll in turn do the same. it's def a 2 way street.

Editorial Team / Moderator · Feb 2, 2010

With some men, all you have to do is ask, and with others, you have to bolster their ego. Its almost like dating without dinner and a movie sometimes.

BWA HA HA HA!! I almost spit my coffee out when I read that, I was laughing so hard.

emt123277 · Feb 3, 2010

I've been on both sides of the fence. Type A personalities dominate the ED setting. Sometimes we need to walk in each others shoes to see how the view changes.

I can't see saying EMTs as a whole are harder to work with than CNAs or insinuating that all EMS providers are males and males as a whole are harder to work with. There are pricks in both sexes and in every specialty. I don't expect an EMT to hang blood and they don't expect me to drop an ETT but in the end it's the same patient with the common goal.

You don't think that there are 100 new grad RNs every May or at least 30 new EMTs every 4 months that would want a job? Time to get along people.

gardengal1, ASN, RN · Feb 3, 2010

We have the same situation in our ER. I know that a lot of ER tasks are grunt work but everyone shares the wealth. And I know that these tasks are not as "exciting" as what goes on in the field. BUT, you took this job knowing what the work load involved and you need to pull your own weight. Have had this conversation with the paramedics. Reception is often cool but work performance often improves for at least a short while after one of these conversations.

getoverit, BSN, RN, EMT-P · Feb 4, 2010

I've had CNAs who didn't want to do what I had asked them (note: I didn't give them an order because I don't like "telling people what to do"). I just did the task myself. It says more about them than anything else.

Like other people said, I think the key is showing respect. It's one of those things you usually have to give before you can receive.

Working part-time as a paramedic with the FD, I bring people into the ER and nurses will tell me "well, you're just a medic but as a nurse we have to know a whole lot more about....." yadda, yadda, yadda. My partners are amazed that I never tell them I'm an RN as well. Because at that point, it really doesn't matter. I always say "wow, you have a lot of responsibilities." It makes things run more smoothly.

I understand your point about "taking orders", maybe if you approached it from the viewpoint of: we are an ER team. things need to be done and if you haven't taken the initiative then you may need to be given some direction or guidance. Does anyone have to tell you to clean your ambulance after a call? of course not, you do it because you know it has to be done. The same thing exists inside the ER or anywhere else for that matter.

We have a male CNA who is difficult to work with. Everything's a catastrophe and he has a million reasons why he can't help with stuff. to be honest I'm pretty much over it. it's a blessing and a curse that he calls out sick so much.

RoyalNurse · Feb 4, 2010

I agree with the respect issue. I've been an EMT for like 9 years now. We get blown off by RNs all the time esp when im trying to give report. It's almost like they don't care what we have to tell them. It's as almost if all I am is damn taxi to bring patients there and back and that's it. Then when we find something out of the normal and tell a nurse about it during report they either don't believe us, or insult or intelligence by checking (as we are telling them) what we found. I had a guy with pneumonia and he had rales on one side and not the other. It was clear rales, couldn't miss em. Well I get to the ED and I'm giving report...xx Y/O c/o SOB times X amount of days, Spo2 is _ on _ and lungs have rales on the right and whatever on the left. As I'm telling her this she goes to check his lung sounds. I said to her what you didn't believe me or didn't think I know what I was talking about? She said no I just had to check for myself. I said rightyfully so, but the least you could do is listen to me first and then do your assessment instead of blowing me off. I found her at the RN station and I flipped around my badge and I said just so you know I'm not a moron as you might have thought and I actually do know what I'm talking about.
In short treat us as we are all on the same team, listen to our reports and don't insult our intelligence. Help make our lives easy and we'll in turn do the same. it's def a 2 way street.

You know what, I am guilty of doing that: blowing off the paramedic/EMT when they bring the patient in and are trying to give me report. :eek: It just seemed to waste time when I'm trying to get their vitals, get an EKG and put them in the system, when I can ask the patient myself about their PMH, medications, and what happened. I usually don't get assessments from the EMTs/paramedics. I didn't even realize that would offend anyone, I guess I have to look at my own behavior. However, I would recheck what a MD or anyone told me he found as far as lung sounds go. But I never thought of paramedics/EMTs as morons, just the opposite.