Hi again, I worked as a CNA for 5 years, then graduated and worked with CNAs as an RN for 2 years in a CVICU. I became very comfortable with the CNA/RN relationship.
Then I moved to the ED, and started working with EMTs.
It's obvious some of them don't like nurses, I've heard comments like "Only a nurse could mess up cables that bad", or "These nurses need to be trained how to clean". When I ask one of them on my "team" to help out with the 3 patients we got at the same time, maybe start an IV or something, they give me attitude: "I don't need to be told how to do my job". When I don't say anything, and wait for them to do their job, I end up drowning, they don't seem to be able to see what needs to be done. (ie chatting in the clean utility room with another EMT while I'm running my a-- off) I have NO PROBLEM doing everything: cleaning, starting IVs, stocking, putting people on/off the bedpan, etc...I just can't do everything all at once, and I AM trained to be an RN and do RN stuff: assess, triage, medicate, monitor, call doctors, call floor nurses, etc...
I've never had this many problems with CNAs, usually once you show them you're willing to do what they do, they're more than willing to help. Not so much with the EMTs, they seem to not want to take "orders" from a female nurse. But I don't know how to ask them without it seeming like an order...
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
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.
*** They are not our equals. True they are used to more autonomy in the field but they have chosen not to work in the "field". Highly trained? I don't think so. When I took the EMT course it was like one semester very part time at a local community college. Paramedic certainly are highly trained but EMTs are not.
My hospitals medical transport service (air and ground) run teams of RN and Paramedic. It is the RN who is the team leader and makes the final decision.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Why are EMTs and paramedics being hired and used in the ED anyway? Their job is pre-hospital. The ED where I work does not use them nor should they. However it is wrong (and dangerous) for the RN to blow off the report from the medics who are bringing them in.
Anyone else notice how the assumption throughout this threat is that the medics are men and the RNs are women?
*** They are not our equals. True they are used to more autonomy in the field but they have chosen not to work in the "field". Highly trained? I don't think so. When I took the EMT course it was like one semester very part time at a local community college. Paramedic certainly are highly trained but EMTs are not.
My hospitals medical transport service (air and ground) run teams of RN and Paramedic. It is the RN who is the team leader and makes the final decision.
I never said they were our equals. However, our EMT-Paramedics have a two year degree, same as me. Many of them have been paramedics for years, and have certainly been in the ED longer than me. So yes, there are areas of greater knowledge and experience that they have, and I honor that. Sure, the final decision may be mine, but I will consider the input of ALL of my team members, and do not make a practice of running rough shod over them simply because "I am the RN".
As far as starting the assessment while the medics are still trying to give report, yes, it is rude. I understand the temptation to do this, as we have a very busy ED and every second is a second that I need to be doing something else, that I should have done five minutes ago. However, I give the medics my full attention and eye contact and let them give report so that *they can get out of there*. They have to give report, and they cannot leave until they have done so, and their time is valuable as well.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
....actually, the final decision is the M.D.'s.....
*** Actually, it not. As my example was medical transport there is no MD involved. The transport team operates under standing orders and protocols and it is the RN who makes the final decision and is ultimately responsible.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
I never said they were our equals.
*** No, you said "I treat them as my equals".
However, our EMT-Paramedics have a two year degree, same as me. Many of them have been paramedics for years, and have certainly been in the ED longer than me.
*** Ya, they are highly trained, just like I stated. However unlike you I do not view EMTs as highly trained.
but I will consider the input of ALL of my team members, and do not make a practice of running rough shod over them simply because "I am the RN".
*** Of course not. To disreguard to imput of other team members is not in the interest of good patient care. My question is why are prehospital types being hired and used inside the hospital? Except to drop off patients in the ED or whatever unit in the case of a direct admit and giving report what are they doing inside the hospital? I work in ICU and ED and we do not use prehospital people inside the hospital, except that the transport medics do occasional education shifts in ICU and ER. Why is this done at some hospitals?
*** Actually, it not. As my example was medical transport there is no MD involved. The transport team operates under standing orders and protocols and it is the RN who makes the final decision and is ultimately responsible.
In regards to "it's the nurses final decision pre-hospital" - It isn't, it's ALWAYS the doc's decision whether you want to believe me or not. Medical command makes all decisions regardless of you're pre-hospital qualification. Standing orders are decided by a board of physicians and placed into use by the transport service's medical director. A symptomatic hypoglycemic patient get's a line and amp of D50? That's a standing order (protocol) instituted by physicians to be carried out in the field. Consider it a pre-printed order sheet signed by a doc in the front of a chart, only you memorize it and treat according to an algorhythm instead of pulling it up in the Pyxis.
EMT's are our equal? No. Should you actually be saying that?? Absolutely not. Everyone has a place in the pt care line whether it's an EMT with 180 hours of classroom or a nurse with 2 years or more. The problem is when you start treating people as though they are beneath you, you create animosity that disrupts the pt care line and the only one that suffers is the pt.
Finally, yes, I too will check my own assessment of any pt coming my way for care. This is regardless of the level of care being transferred to me. I assess all pts for myself whether the report is coming from an EMT, another nurse, or an MD from their office. I am also not an idiot and can listen to your report while I assess. Another side note here to EMS: That's special that you get us a list of meds from the residence before you transported the stable, non-emergent pt to my ER but I need DOSAGE and FREQUENCY as well. We are required to complete a med reconciliation for the pt and this info is required. When I ask the pt they often respond "I don't know, the little yellow one for my blood pressure" so please get the dose and schedule too.
I work EMS too, how many times do you call a report into the receiving facility over the radio or cell and then get asked all the same questions when you walk in the door again? I think this has happened EVERY time I called a report over the past 13 years as an EMT. You honestly need to get thicker skin if your biggest complaint that no one listens when you talk. In fact, we do listen but we're good at pretending we don't.
Another side note here to EMS: That's special that you get us a list of meds from the residence before you transported the stable, non-emergent pt to my ER but I need DOSAGE and FREQUENCY as well. We are required to complete a med reconciliation for the pt and this info is required. When I ask the pt they often respond "I don't know, the little yellow one for my blood pressure" so please get the dose and schedule too.
AMEN!!!
Also, I too check everything for myself when I get a pt from EMS. This has absolutely NOTHING to do with me not believing the EMT or questioning their skills and/or abilities. I need to see and hear everything for myself so that when things change or the pt is crapping out, I can tell the doc what's different. I can just see it if I didn't do that and the doc asked me what the pt was like when he/she came in. "Well Dr. so and so, I don't know because I didn't listen to the pts lungs myself, but EMS said she had some rhonchi on the left side." That would go over well. I think everybody needs to toughen up a little bit. Me doing my job should not be taken as a personal insult to the EMT.
I don't think doing your own assessment is the issue. That's basic nursing. I can understand how starting your assessment while the medic is still talking could be considered rude, however.
I don't think doing your own assessment is the issue. That's basic nursing. I can understand how starting your assessment while the medic is still talking could be considered rude, however.
It probably is rude, but when you already have 4 patients waiting for you, and the goal is to get the new patient "on the board" within 10 minutes of arrival, and you have to know how they sound/look so you can triage the patient...the best time to get the assessment is when they first arrive. I get the basics of the story, put them in the computer, get their vital signs, then listen to lungs, heart, look at the broken leg/arm...etc... If anyone's still talking at this point, I'm half listening...if there's something important to say, should probably be said within the first 2 minutes of arrival... I hate having to hurry and be rude, but there's a basic cut-throat attitude you have to have in the ER...or you drown.
PMFB-RN, RN
5,351 Posts
*** They are not our equals. True they are used to more autonomy in the field but they have chosen not to work in the "field". Highly trained? I don't think so. When I took the EMT course it was like one semester very part time at a local community college. Paramedic certainly are highly trained but EMTs are not.
My hospitals medical transport service (air and ground) run teams of RN and Paramedic. It is the RN who is the team leader and makes the final decision.