# So I got fired...



## Jeremy89 (Sep 21, 2010)

... from an ER Tech position for allegedly being "in the process" of starting an IV (I'm an EMT-B but we have advanced skills training through the hospital).

Here's what happened:

A patient came in c/o weakness/fatigue. He was brady into the 40's with an A/V block on his EKG- Dr ordered an iStat (quick blood test in the ED for electrolytes and the like) and a line/labs. I took the pt back to a monitored bed from our "fast track" area, got him hooked up and went to prepare him for an IV since the MD ordered it. I simply put a tourniquet on to look for veins (and start it if the nurse would let me) since the RN wasn't there yet.  I didn't even clean the skin, nor did I take out a needle.  Finally the RN walked in, I asked if I could do it; he said no and took over (He's very egotistical and doesn't like Tech's starting lines or doing anything but bedpan duty.  We have never gotten along and I always felt like he was analyzing everything I did to find every little mistake). I left thinking nothing of it, but apparently he told my manager that I was "in the process of starting an IV" that was not delegated to me (an RN must delegate, not a physician), which resulted in my termination.

This was a complete shock to me.  I had been warned previously regarding IVs: once I got in trouble for switching EMS IV tubing to a Saline lock- (I was unaware we couldn't do that) and another time for looking for veins and offering to start an IV on a patient who was coding on one of the Med/Surg floors (it wasn't specified that our skills were only good in the ED).

Just wanted to get everyone's opinion on this and see if I'm the only one who thinks this is complete bull....

Thanks!


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## bstone (Sep 21, 2010)

Appeal it to HR. Are you in a union? Talk to your union rep.


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## socalmedic (Sep 21, 2010)

sounds like you where warned before and should have known better, what did you expect to happen. when management tells you not to do something twice and you go and do it again you are now a liability.

"doing the same action repeatedly and expecting different results is the definition of insanity" --Albert Einstein


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## bstone (Sep 21, 2010)

socalmedic said:


> sounds like you where warned before and should have known better, what did you expect to happen. when management tells you not to do something twice and you go and do it again you are now a liability.
> 
> "doing the same action repeatedly and expecting different results is the definition of insanity" --Albert Einstein



He may have pushed it a little bit- possibly been a little bit too excited- but he didn't do any procedures and only was setting things up. We don't fire EMT-Bs for setting up a drip set or putting on a constricting band when the Intermediate or Medic comes along to start the line, do we?

In fact, there is a course called Paramedic Assistant that teaches exactly how to do these things!


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## JPINFV (Sep 21, 2010)

bstone said:


> He may have pushed it a little bit- possibly been a little bit too excited- but he didn't do any procedures and only was setting things up. We don't fire EMT-Bs for setting up a drip set or putting on a constricting band when the Intermediate or Medic comes along to start the line, do we?



So I've got a patient who needs an IV, I have a tourniqute on the patient and am palpating for a vein. What exactly does it look like I'm getting prepared to do outside of preparing to start an IV?

You do expect termination if you've been told not to do something before and he's been warned twice before for fiddling with IVs sans permission and oversight. Perception is reality, and if it's perceived that you're attempting to do something you aren't supposed (even if you aren't), then you were attempting to do something you weren't supposed to. Just because someone was caught (again, perception=reality) him before he was able to start an IV just means he got caught before he started an IV. 

Based on the information provided, I would definitely appeal and do my best to change perception from "starting an IV" to "preparing for the RN and taking a look for my own experience." If an appeal is granted, I would definitely in the future limit fiddling with a patient in regards to an IV (and, to use a crude analogy, you don't put on a condom to go out and eat dinner. You put it on to...) prior to permission from the patient's RN.


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## LonghornMedic (Sep 21, 2010)

In light of the fact you had issues with IV's before, why would you even attempt this? And why attempt this with a nurse you have had problems with in the past? It says in your sig line that you are a RN student. RN's do *NOTHING *until given orders. It's best you learn from this mistake now and carry that over to your future nursing career. Best of luck.


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## JPINFV (Sep 21, 2010)

LonghornMedic said:


> RN's do *NOTHING *until given orders.


Neither do paramedics if you want to argue this to the same letter you're arguing. However both RNs and paramedics can follow standing orders/offline protocols.


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## JJR512 (Sep 21, 2010)

socalmedic said:


> sounds like you where warned before and should have known better, what did you expect to happen. when management tells you not to do something twice and you go and do it again you are now a liability.
> 
> "doing the same action repeatedly and expecting different results is the definition of insanity" --Albert Einstein



Wrong. Go back and re-read what the OP actually wrote regarding what he'd been warned about in the past. Hint: neither of the two previous warnings dealt with what he was fired for in this instance. One warning was for switching IV tubing to a saline lock; the other warning was for offering to start an IV on a patient coding on a Med/Surg floor. In the latter situation, the problem was specifically that he is only allowed to do that in the ER. Well, it was in the ER where he offered to do it this time, so the warning about not doing it out of the ER does not apply.

Oh, and just for the record, Albert Einstein was not a psychiatrist or psychologist. That quote, and variations thereof, have also been attributed to Benjamin Franklin, an old Chinese proverb, and several other sources. I wouldn't put too much stock in that saying, though, unless you also think that parents who teach their kids, "If at first you don't succeed, try and try again," are teaching their kids to be insane.


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## LonghornMedic (Sep 21, 2010)

JPINFV said:


> Neither do paramedics if you want to argue this to the same letter you're arguing. However both RNs and paramedics can follow standing orders/offline protocols.




Depends where you work. Where I work now and where I have worked before, I rarely have to call a hospital to get any orders. It's been over a year since the last time. We have very liberal standing orders and protocols. We can do more in the field with autonomy than any nurse in a ER.


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## Shishkabob (Sep 21, 2010)

LonghornMedic said:


> Depends where you work. Where I work now and where I have worked before, I rarely have to call a hospital to get any orders. It's been over a year since the last time. We have very liberal standing orders and protocols. We can do more in the field with autonomy than any nurse in a ER.



Just because I want to beat jp to thee punch....

Protocols ARE orders.


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## aewin90 (Sep 21, 2010)

JJR512 said:


> Wrong. Go back and re-read what the OP actually wrote regarding what he'd been warned about in the past.


The OP had not been warned about _starting_ IV's, but he had been warned about things _with regards_ to IV's.  This last incident was with regards to an IV, though not identical to past warnings.

Here we have an EMT who was flirting with things outside his scope of practice, which is a huge liability for the emergency department should something go awry.  Even so, I do not necessarily believe termination was justified, and I would appeal it.


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## LonghornMedic (Sep 21, 2010)

Linuss said:


> Just because I want to beat jp to thee punch....
> 
> Protocols ARE orders.



Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.


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## Flight-LP (Sep 21, 2010)

LonghornMedic said:


> Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.



Incorrect. Many ER and ICU nurses also have standing orders, just the same as yours.


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## akflightmedic (Sep 21, 2010)

LonghornMedic said:


> Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.



What century are you operating in??? RNs have "standing orders" as well, so I am not sure where you come off saying that. I have worked in ERs and on the floor for many years and nurses had a lot of "scope to practice".

Also, most other allied health professionals are that...allies. They communicate, cooperate and coordinate a plan best suited for the patient. If you think our one on one in the back of an ambulance and the coolness factor of being able to give morphine without asking trumps a team approach to the best health care delivery, then maybe you are a lost cause.


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## akflightmedic (Sep 21, 2010)

In regards to the OP...I am going to take the cynical side and say maybe you were a square peg trying to fit in a round hole. You had been counseled previously and these were the events that actually made it in writing.

Experience has proven to me time and again, there is always more to the story either by intentional omission or simply the inability to perceive the severity of previous non written warnings about these IV incidents or other things as well.

None of us know as we were not there and we can only rely on your side of the story. You also were very quick to turn it into a persecution (the nurse who hates you) situation and also used the defense of "I wasn't really gonna do it". 

I wonder if I walked into a bank and said give me all your money...would they believe me when I said, I was just testing/teasing, not really gonna do it despite what it looks like (as the officers surround me)?


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## Flight-LP (Sep 21, 2010)

Jeremy89 said:


> ... from an ER Tech position for allegedly being "in the process" of starting an IV (I'm an EMT-B but we have advanced skills training through the hospital).
> 
> Here's what happened:
> 
> ...



Are these "advanced skills" you mentioned covered in your written job description?

Regardless of your personal interpretation or assumptions of the RN's intentions, you are still an ancillary, unlicensed individual working under the delegation of an RN. If the RN says no, thats the end of that conversation. If you know that this particular RN is somewhat limiting in their delegation, then you should consider not pushing their boundaries. Chances are you will not win this battle. Chock it up to a learning experience and move on...........

Just my $.02 worth.


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## Flight-LP (Sep 21, 2010)

Whoops, sorry AK, guess we were on the same wave length this morning!


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## Scott33 (Sep 21, 2010)

LonghornMedic said:


> Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't.



May have been the case during the Crimean War, but not these days.

Seeing that the RN is usually the first point of contact for the patient who presents to the ED, most facilities will have standing orders which will cover your typical "rule out" presentations (bellies, PNA, CP, N/V, etc). 

In some instances, it is not uncommon for a complete set of lab work and imaging to be available to the Doc, long before they have seen the patient. Most EDs in the country would grind to a halt if it were to be done any other way. 

As for the Morphine argument, different states have different protocols and you will find that some EMS systems still have to ask for permission to use it.


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## aewin90 (Sep 21, 2010)

[tangent]

RN's my local ER do not have standing orders.  However:

-It is a rural hospital with only eight exam rooms and two trauma rooms.
-It is ranked as the worst ER in the state (and has a reputation as one of the slowest).

I have been to that ER about ten times and have been correctly diagnosed only once, by the one doctor who chooses to use diagnostic tests.  We usually go to the "real" doctor after a trip to the ER.  

Maybe one day they will be introduced to the wonderful world of standing orders and protocols...?

[/tangent]


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## Level1pedstech (Sep 21, 2010)

LonghornMedic said:


> Depends where you work. Where I work now and where I have worked before, I rarely have to call a hospital to get any orders. It's been over a year since the last time. We have very liberal standing orders and protocols. We can do more in the field with autonomy than any nurse in a ER.



 Really, any nurse does that include any nurse in any ER or just nurses in your part of the world? Got the old broad brush out and gave it a swing with that statement. I bet there are a few ER RN s out there that would love to diagree with you.


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## JPINFV (Sep 21, 2010)

Shakes tiny fists of anger over being late to the "standing orders are standing orders, protocols are standing orders" comment. I'll also like to add that outside a handful of systems that have started to develop patient specific protocols to address specific community members with special medical needs, RNs can get additional PRN orders specific to their patient while paramedics are limited to just the standing orders.


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## Level1pedstech (Sep 21, 2010)

Jeremy89 said:


> ... from an ER Tech position for allegedly being "in the process" of starting an IV (I'm an EMT-B but we have advanced skills training through the hospital).
> 
> Here's what happened:
> 
> ...



 Over the years I have seen people struggle in the ER both as RN's and as techs. Usually a person will have difficulty when they come into the ER with no previous experience working in a busy fast moving atmosphere. But another bigger and somewhat over looked problem is people that just don't fit the culture in the ER,I like the previously mentioned square peg round hole analogy its a good way to describe people who don't fit in the ER.

 Unless you have spent some paid time working in the ER its hard for people to understand the dynamic present and how one person can really make things difficult for everyone else. I may not be crazy about everyone I work with on every shift but I always try to maintain a certain level of respect and trust. I think there might be more to your story,I just don't see an RN writing up a tech for looking for veins or putting on a lock,this is another time where the trust and respect thing comes into play. It may not be in your job description but an RN to tech warning seems to be more appropriate in this situation at least the first time then maybe a written warning and maybe a suspension followed by termination. Every employer has their own unique system of discipline and yours just might be extra tough.

 Part of being a competent tech is being able to respect that fine line and always stay within your scope of practice. Yes we do often find ourselves involved in procedures that are way above our scope of practice but usually its in the role of "assistant" with an RN,PA or MD at your side or at least close by. I wont go any further with that because your already in enough trouble and encouraging you or anyone else to venture over the line would be irresponsible. Every situation is different and you need to know and respect your boundaries. Having the complete trust of your fellow staff members is crucial and that seems to be missing in your case.

 It sounds to me like somewhere along the line you became a thorn in the butt of your manager or director as well as at least one of your team members and lost that trust and respect. If that's the case your done and should just move on,if you have the union you may be able to get back in but would you really want to go back and work in what would probably be a hostile environment knowing you will be scrutinized every time you make a move? Also why should they give you another chance when there are probably a hundred or more people waiting in line to grab that job.

 I don't mean to be cruel but it sounds like you really screwed up a good thing, now you need to learn from your mistakes and move on. It wont be easy especially if your in an area where such news travels like wildfire,your reputation will follow you in this business so you may need to do some big time damage control. Good luck!


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## Veneficus (Sep 21, 2010)

Jeremy89 said:


> Just wanted to get everyone's opinion on this and see if I'm the only one who thinks this is complete bull....
> 
> Thanks!



Nope, not bull.

One of the most important aspects in finding a job is to find one where the workplace culture fits in with your personality. 

For example, if you are a very liberal person, working for a conservative organization or an organization where conservative people prevail is not going to go well. 

Perhaps one of the most important things in healthcare is knowing what you can and cannot do, when you need to ask permission before, or when you can get "permission" after. This can also apply to where you are at and when you have multiple roles. Just because you know how to do something doesn't grant you some pseudopermission to do it. 

From your narative, and I imagine also it is not the whole story, you have absolutely no idea what your boundries are. At the very least you are on your third strike. 

I do not think unions should protect such people ever. In fact one of my biggest problems with them is they protect the most useless people from being rightfully terminated for failing to meet organizational standards, most often out of apathy or outright laziness.

Again from your description, it sounds like you can anticipate the needs of various situations. Which is a positive virtue. But it also seems like you are working in a place that doesn't really want that. 

Some bosses are strict, some more leanient. But they are still the boss, and what one lets you do doesn't automatically translate to what another has or wants you to do. 

Could I just point out:

In your story about changing IV fluid to a lock, was there an order to administer fluid or discontinue it for that patient at that time or were you basing the decison off of what is usually done?

I imagine you were on a floor because you were transferring a patient when you happened across a code? 

It may surprise you to learn this, but many departments don't exactly "look up to" the ED staff. Usually, random providers from other departments are not really appreciated. it is your responsibility to kow where you are permitted to function, how and when. "you had no idea" doesn't exactly paint a shiney picture of your knowledge of your responsibilities. Your prolonged absence could als have been holding up patient flow in the ED, so you department may have been uffering while you were out freelancing around.

If somebody put a constricting band on a patient, and was "looking for a vein" as far as I am concerned, they are starting an IV. If they have no ability to properly clean the site, or are not set up prior to with their equipment, it looks to me like they are doing a poor job of it. 

I have never known anyone who could start IV therapy or place a catheter who needed somebody to find a vein for them. The very argument sounds crazy. 

For a moment, let's pretend you are working with me. (not really realistic because I don't really care who starts an IV as long as it is done in a acceptable way, but lets consider) If you put a TK on a patients right side, and showed me where a vein was, etc, you may have wasted your time. I am left handed, so whenever possible I like to work from the patients left side. Not that I can't work on the right side, but I usually like to choose my ground and when possible be in a position of strength.  

Perhaps I need a more proximal or distal site? Perhaps I was a site away from a joint, I never like to use the hands. (too small of facial compartments in life altering area) But sometimes I cannot be so picky. (those times are rare) So really your impression of help is no help at all. 

If you knew this nurse was exceptionally tyranical and didn't like you, why would you give him any reason to report anything you did? I would steer well clear and let him sink o his own. Infact I'd find a friendlier person to make sure I was already "busy" for them, just to get away from him.

Consider it a learning experience, and move on. It may suck, but if you are in RN school, go flip burgers till you are finished and can choose your job instead of lamenting a tech postion.


The nurse vs medic argument is old and tired and utterly pointless. Neither side can claim "victory."


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## feldy (Sep 21, 2010)

while i worked as a volunteer in the ED this summer, essentially I had a very similar role as a tech. However, while i knew and had practiced certain things that were out of my scope as an EMT and especially as a volunteer, I always aired on the side of caution. I think there was one thing where I was told after the fact that next time let one of the techs do that, but that was because I was never told that I was not allowed to do that.

After that point, I would be asked by certain nurses who did not really know the scope of my postion to do things like splint, take out this person's IV  or what not, but i just told them that the hospital does not allow me to do that, I would if i could but i shouldnt. 

I think in the situation of the op and my situation, especially with such a limited scope, always aire on the side of caution, unless you are 100% sure that you are allowed to do something, then be honest and ask someone else to do it.


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## Jeremy89 (Sep 21, 2010)

Wow, Thanks for the replies everyone!!

I would like to encourage everyone to re-read my original post just for clarification.

I just wanted to specify a few things:

1. For everyone who suggested that I appeal it, well I met with the head of HR shortly after and let him know what was going on.  He looked into it and wasn't able to offer my job back but he did say that no one is ever ineligible for rehire with the company (who happens to own half the hospitals in Phoenix).

2. There is nothing wrong with "looking for veins".  That doesn't mean that I was "in the process of starting an IV"- I could have drawn the blood without RN delegation, or I could have been looking for veins, in the event that the patient goes downhill quickly, I could say "hey, his R AC feels great".  The physician DID order it so I knew either way it was getting started, either by me or the RN.  

My job as an ED tech was to anticipate what was going to happen and to prepare items for procedures or whatnot- if a patient is short of breath and their Sats are dropping, I'll grab the code cart just as a precaution, should we need to RSI.  If a nurse gets Propofol out of the Pyxis, I need to make sure a pump is in the room.  If we're taking a vented pt up to the unit, I need to ensure there is adequate O2 and a BVM on the bed.  I knew this specific patient was getting an IV so I chose to prepare all the items for whomever was to start it.

3. With regards to my training, it was very very vague- we discussed general IV insertion and put a 22ga in a fake arm and we were done.  They didn't specify anything except we could only draw blood from the line when it was started and that we would not be giving any fluids other than the NS pre-filled flush at the time of insertion.  The instructor said "Any RN can sign you off", thus explaining my previous warning.  The other time when the RN asked me to switch over the line, I obviously said yes.  I figured if the RN was asking me then it was within my scope.

4. For everyone saying there's more to the story, there really isn't.  There were the more reserved techs that worked there who just did what they were told, nothing more.  As a nursing major, I couldn't stand working as a "dumbed down" tech who wasn't allowed to share and utilize what I knew.  I was warned previously about IVs because no one specified anything about our scope of practice.  Seriously- none of the other techs knew what we were specifically allowed to do.  Once I had an MD put a syringe of Viscous Lidocaine on the table while I put a foley in.  I didn't think twice about it- I mean its just lidocaine, right? I asked my Senior Clinical Manager (the one who fired me) and she referred me to our clinical educator and even he said it was "in the grey area".  I've had nurses ask me to get Epi out of the code cart and pop the cap to prepare the pre-filled syringe. Again, a nurse asked me to so I assumed it was within my scope.  Maybe its my fault for not knowing my scope, but if my educator can't even specify it, I don't know who can.

5.  Finally, the date of my second warning was in April.  I wasn't fired until July.  This should tell you that I was able to improve my behavior and that all was good for over 3 months (and wasn't even "bad" when I got fired- I didn't do anything out of my scope).


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## Jeremy89 (Sep 21, 2010)

Veneficus said:


> Again from your description, it sounds like you can anticipate the needs of various situations. Which is a positive virtue. But it also seems like you are working in a place that doesn't really want that.



This is true 



> In your story about changing IV fluid to a lock, was there an order to administer fluid or discontinue it for that patient at that time or were you basing the decison off of what is usually done?


See my above post- it was delegated by the RN.



> I imagine you were on a floor because you were transferring a patient when you happened across a code?
> 
> It may surprise you to learn this, but many departments don't exactly "look up to" the ED staff. Usually, random providers from other departments are not really appreciated. it is your responsibility to kow where you are permitted to function, how and when. "you had no idea" doesn't exactly paint a shiney picture of your knowledge of your responsibilities. Your prolonged absence could als have been holding up patient flow in the ED, so you department may have been uffering while you were out freelancing around.






> If somebody put a constricting band on a patient, and was "looking for a vein" as far as I am concerned, they are starting an IV. If they have no ability to properly clean the site, or are not set up prior to with their equipment, it looks to me like they are doing a poor job of it.
> 
> I have never known anyone who could start IV therapy or place a catheter who needed somebody to find a vein for them. The very argument sounds crazy.



Obviously you don't work in an ED.  Its all about anticipation- the guy had symptomatic bradycardia.  Who knows if or when is AV node would stop firing?  Like I said, the RN was busy with his other 2 pt's (since he didn't let techs help him out- the whole purpose of our extended skills).  I wanted to stay with the patient until the RN came in, should anything happen.  But I wasn't just going to stand there when I could be doing something productive.



> For a moment, let's pretend you are working with me. (not really realistic because I don't really care who starts an IV as long as it is done in a acceptable way, but lets consider) If you put a TK on a patients right side, and showed me where a vein was, etc, you may have wasted your time. I am left handed, so whenever possible I like to work from the patients left side. Not that I can't work on the right side, but I usually like to choose my ground and when possible be in a position of strength.
> 
> Perhaps I need a more proximal or distal site? Perhaps I was a site away from a joint, I never like to use the hands. (too small of facial compartments in life altering area) But sometimes I cannot be so picky. (those times are rare) So really your impression of help is no help at all.



Exactly, but it couldn't hurt to look in the rare case that RN would let me start one (he did once- I was shocked).  I have learned to anticipate the size and location of the IV- this guy very well could get a CT Angio Chest so he'd need an 18+ in the AC.



> If you knew this nurse was exceptionally tyranical and didn't like you, why would you give him any reason to report anything you did? I would steer well clear and let him sink o his own. Infact I'd find a friendlier person to make sure I was already "busy" for them, just to get away from him.
> 
> Consider it a learning experience, and move on. It may suck, but if you are in RN school, go flip burgers till you are finished and can choose your job instead of lamenting a tech postion.



Touché-  Most likely I'll head back to Target where I worked before.  Not my first choice, but as I mentioned, I can't stand working under my education level.


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## Jeremy89 (Sep 21, 2010)

RE: Working the code

I was picking up hours in the EKG department and got called up for a Rapid Response.  When the patient coded I wasn't just gonna sit there and watch these MedSurg nurses fumble around the code cart when I know it inside and out.  Besides, its not like the patient needed an EKG while he was coding!! Might as well make myself useful.


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## JPINFV (Sep 21, 2010)

Jeremy89 said:


> 2. There is nothing wrong with "looking for veins".  That doesn't mean that I was "in the process of starting an IV"- I could have drawn the blood without RN delegation, or I could have been looking for veins, in the event that the patient goes downhill quickly, I could say "hey, his R AC feels great".  The physician DID order it so I knew either way it was getting started, either by me or the RN.


I don't think anyone is buying this. If it walks like a duck and quacks like a duck, it's a duck.

I go trap shooting (shotgun shooting) every week or two. At the range I go to, if an employee is in the trap house they put an orange traffic cone on top as a warning that someone is downrange on that range. If I'm at a station with my shotgun pointed down range, then I'm preparing to take a target and a danger to the technician, regardless of if my shotgun is loaded and the action closed or if I'm just getting a feel for shouldering my firearm. 

Similarly, if you have a tourniquet on the patient and looking for a vein, you are preparing to start an IV, regardless of whether you mean to or not.  



> My job as ... I knew this specific patient was getting an IV so I chose to prepare all the items for whomever was to start it.


You went past preparing the items to initiating the initial steps of the intervention.


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## JPINFV (Sep 21, 2010)

Jeremy89 said:


> Obviously you don't work in an ED.  Its all about anticipation- the guy had symptomatic bradycardia.  Who knows if or when is AV node would stop firing?  Like I said, the RN was busy with his other 2 pt's (since he didn't let techs help him out- the whole purpose of our extended skills).  I wanted to stay with the patient until the RN came in, should anything happen.  But I wasn't just going to stand there when I could be doing something productive.



Let's assume that the patient goes into a 3rd degree AV block and becomes unstable. The first line tx isn't an IV medication. So if you were so concerned that you were futzing around with an IV, were you also prepared to futz around with the defibrillator?


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## Hockey (Sep 21, 2010)

Reason #294458486471.9 why I refuse to work in an ER.  Too much BS.  Too much drama


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## Shishkabob (Sep 21, 2010)

JPINFV said:


> RNs can get additional PRN orders specific to their patient while paramedics are limited to just the standing orders.



Well that's just not true either.


I can call my med control, or the receiving hospital, and speak and consult with the receiving physician and deviate from protocols... all PRN.  Kinda the point of On-Line Medical Control, is it not?


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## JPINFV (Sep 21, 2010)

Linuss said:


> Well that's just not true either.
> 
> 
> I can call my med control, or the receiving hospital, and speak and consult with the receiving physician and deviate from protocols... all PRN.  Kinda the point of On-Line Medical Control, is it not?



I'd argue calling in and asking for an order isn't all that PRN'ish. However, it's true that online control can always go, "administer X and if it doesn't resolve administer X more." Of course the unsaid difference is EMS is all of what, less than an hour normally from patient contact to hand off? However the physician doesn't want to get a call at O'dark 30 that the patient has a fever and needs Tylenol, which could easily be resolved by a PRN order.


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## JJR512 (Sep 21, 2010)

JPINFV said:


> Similarly, if you have a tourniquet on the patient and looking for a vein, you are preparing to start an IV, regardless of whether you mean to or not.



Preparing to start an IV is not the same as starting an IV. The OP was fired for doing something that he was only preparing to do, not actually doing.

If I'm putting toothpaste on my toothbrush, I'm preparing to brush my teeth, but I'm not brushing my teeth. If I'm getting in a car, putting on my seatbelt, and getting out my keys, I'm preparing to drive the car, but I'm not driving the car.

I'm re-taking an EMT-B course now because my original certification expired last year, and I did not renew it then (that's a story for another time/place). It's early in the course, and at this time, we are not allowed to have patient contact. We are allowed to go out on the ambulance as an observer, and as observers, we are allowed to get out the O2, get out a nasal cannula, set it all up and get it ready, but we are not allowed to actually place the cannula on the patient. The instructor has explained that at this point in our training, patient contact is practicing medicine without a license, which is, if I recall correctly, a Class D Felony. But by your logic, setting up the O2 and the cannula is the same as placing the patient on oxygen, so I'm already guilty of a felony.

The State's Attorney's Office for Howard County, Maryland, can be reached at 410-313-3100, if you'd like to report me.


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## feldy (Sep 21, 2010)

JJR512 said:


> Preparing to start an IV is not the same as starting an IV. The OP was fired for doing something that he was only preparing to do, not actually doing.
> 
> If I'm putting toothpaste on my toothbrush, I'm preparing to brush my teeth, but I'm not brushing my teeth. If I'm getting in a car, putting on my seatbelt, and getting out my keys, I'm preparing to drive the car, but I'm not driving the car.
> 
> ...



The difference is here that you did not have pt contact while the op did.

mistakes are made and we learn. Just some quicker than others.


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## JJR512 (Sep 21, 2010)

feldy said:


> The difference is here that you did not have pt contact while the op did.
> 
> mistakes are made and we learn. Just some quicker than others.



The point is not whether or not patient contact occurred. The point is whether or not the line that separates what one is and is not allowed to do is crossed. The point is also that doing something in preparation for an action on the wrong side of that line does not equal doing something on the wrong side of that line.

It's easy for me because my line is clearly defined. Judging by some of the things the OP has said, that line is not so clearly defined for him.


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## JPINFV (Sep 21, 2010)

JJR512 said:


> If I'm getting in a car, putting on my seatbelt, and getting out my keys, I'm preparing to drive the car, but I'm not driving the car.



That's sufficient action to get a drunk driving charge if you're drunk. Also, try loading a firearm at a range at someplace other than the firing line. Sure, you are just preparing to shoot it, but don't be surprised if people treat you like you just discharged it off the firing line.




> I'm re-taking an EMT-B course now because my original certification expired last year, and I did not renew it then (that's a story for another time/place). It's early in the course, and at this time, we are not allowed to have patient contact. We are allowed to go out on the ambulance as an observer, and as observers, we are allowed to get out the O2, get out a nasal cannula, set it all up and get it ready, but we are not allowed to actually place the cannula on the patient. *The instructor has explained that at this point in our training, patient contact is practicing medicine without a license, which is, if I recall correctly, a Class D Felony.* But by your logic, setting up the O2 and the cannula is the same as placing the patient on oxygen, so I'm already guilty of a felony.



Emphasis added.

First, Maryland State law is a pain to go through. However, in general states create a licensure exemption for students in training programs. California's Code of Regulations, for example, explicitly gives supervised EMS students the same scope of practice as the level they are training towards*. A much looser clause is included in the Business and Professions code covering medical students (essentially medical students don't have to be directly supervised). 

Second, what would the paramedics response be if you were alone with a patient for a few minutes while he went and did something (put something away outside, talk to a family member, what ever) and he came back to find you with an IV kit, a tourniquet around a patient's arm and palpating for a vein. After all, it's not illegal to assist with an IV, tie a tourniquet around the patient's arm, or feel for a vein. 





> The State's Attorney's Office for Howard County, Maryland, can be reached at 410-313-3100, if you'd like to report me.



It really is possible to break company policy resulting in termination without breaking the law. 




*


> § 100063. Scope of Practice of Emergency Medical Technician.
> (a) During training, while at the scene of an emergency, during transport of the sick or injured, or during interfacility transfer, a certified EMT or *supervised EMT student* is authorized to do any of the following:


Emphasis added. 
http://www.emsa.ca.gov/laws/files/ch2_emtI.pdf


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## JPINFV (Sep 21, 2010)

JJR512 said:


> The point is also that doing something in preparation for an action on the wrong side of that line does not equal doing something on the wrong side of that line.



Are you suggesting that if someone is preparing to do something bad they shouldn't be stopped until they've actually completed the action?


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## Shishkabob (Sep 21, 2010)

JPINFV said:


> Are you suggesting that if someone is preparing to do something bad they shouldn't be stopped until they've actually completed the action?



Meh, depends.


Whilst there's "conspiracy" to commit a crime, there are also other crimes that don't actually happen until you commit it, regardless of intent.  (Shoplifting isn't shoplifting till you exit the store... you can hid all the merchandise in your clothing you want, but not illegal till you step past the last register, regardless if you walk around telling all the employees you're planning on stealing stuff.)


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## JPINFV (Sep 21, 2010)

Linuss said:


> Meh, depends.
> 
> 
> Whilst there's "conspiracy" to commit a crime, there are also other crimes that don't actually happen until you commit it, regardless of intent.  (Shoplifting isn't shoplifting till you exit the store... you can hid all the merchandise in your clothing you want, but not illegal till you step past the last register, regardless if you walk around telling all the employees you're planning on stealing stuff.)



True, but you don't have to do anything illegal for the store to ask you to leave either.


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## Shishkabob (Sep 21, 2010)

True. 


But for the sake of this thread, let's separate "legal" from "against a private employers policies".


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## JJR512 (Sep 21, 2010)

JPINFV said:


> That's sufficient action to get a drunk driving charge if you're drunk. Also, try loading a firearm at a range at someplace other than the firing line. Sure, you are just preparing to shoot it, but don't be surprised if people treat you like you just discharged it off the firing line.


The first action you mentioned is illegal, and the second action is probably against the facility's policy, if not also illegal. That is why doing either of those things are wrong.



> First, Maryland State law is a pain to go through. However, in general states create a licensure exemption for students in training programs. California's Code of Regulations, for example, explicitly gives supervised EMS students the same scope of practice as the level they are training towards*. A much looser clause is included in the Business and Professions code covering medical students (essentially medical students don't have to be directly supervised).


California's laws mean nothing to me. My understanding of Maryland law is that until we have been trained to a minimum standard, patient contact is not allowed. The minimum standard is completion of Mod 3, by which time we have been trained in patient assessment, which during our field internships, is really the only thing we're supposed to be doing. Until that point, since we haven't been trained to actually do anything, we're not allowed to do anything. I think that makes sense. I have not studied the law, though, so I don't know if any of this is accurate; it's just what the instructor said. If he's erring on the side of caution, no harm done. If he's wrong in the other direction, though, well then I feel I would have been acting on good faith that what the instructor taught was accurate, and there are 29 witnesses to what he taught. 



> Second, what would the paramedics response be if you were alone with a patient for a few minutes while he went and did something (put something away outside, talk to a family member, what ever) and he came back to find you with an IV kit, a tourniquet around a patient's arm and palpating for a vein. After all, it's not illegal to assist with an IV, tie a tourniquet around the patient's arm, or feel for a vein.


You can come up with a million different examples of "what if you did something", and my answer will always be the same: 1. If I was preparing to do an action, then I was not actually doing the action. 2. If preparing to do the action is permitted, then preparing to do the action is not wrong; if preparing to do the action is not permitted, then preparing to do the action is wrong.

So if you want a direct answer to your question, here it is. If I'm allowed to prepare an IV for the paramedic, and the IV is warranted in this situation, and I was doing everything correctly, then hopefully the kind, intelligent paramedic would appreciate my initiative. If I am not allowed to prepare an IV, or it wasn't warranted, or I was doing it wrong, then the paramedic would justifiably be concerned with my action. 



> It really is possible to break company policy resulting in termination without breaking the law.


No...really? Wow. I had no idea it was possible to get fired for breaking my employer's rule, even though the rule wasn't an actual law. Thank you for enhancing my education!



> Emphasis added.
> http://www.emsa.ca.gov/laws/files/ch2_emtI.pdf


I see a "ca.gov" in that link, and again, I'm not really interested in California law. It doesn't apply to me. Also, I don't typically follow links presented as an argument. I feel that if you want to make a point about something, then you should make it yourself, and not require me to go find your point for myself.



> Are you suggesting that if someone is preparing to do something bad they shouldn't be stopped until they've actually completed the action?


I am suggesting that unless someone is in imminent danger of doing something bad, then you should first take a moment to find out what it is, exactly, they are doing and why before you fire them for doing something they haven't actually done yet. If a guy is pointing a gun at a police officer, I feel the officer is justified in immediately shooting that guy for fear that the guy is about to shoot him. I don't think it's reasonable to expect the officer to first say, "Hey, I see you've got that gun there, and you're pointing it at me...Just wondering, you understand, if you're thinking about shooting me, 'cuz you know, I just need to know that before I can decide whether or not I'm going to have to shoot you first?" Now in the situation at hand, apparently, the OP was not found with an IV in his hand, millimeters away from the patient's skin and getting closer. He was found doing some preparatory actions. Was he trying to be helpful for the nurse? Was he really going to start the IV by himself? Some of you have already made up your mind, and sided with the nurse. I'm not that cynical. I don't know the guy so I don't automatically assume the worst of him. I think it would have been more appropriate for the nurse to ask him what he was doing and why, and either thanked him for his initiative, or warn him that even that much was outside his scope of practice.


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## JPINFV (Sep 21, 2010)

JJR512 said:


> The first action you mentioned is illegal, and the second action is probably against the facility's policy, if not also illegal. That is why doing either of those things are wrong.


I know it's illegal, that's why I said it was illegal.

The second one is against facility policy (albeit not illegal), just like looking like you're going to start an IV is against the OP's facility policy. 



> California's laws mean nothing to me.



...and Maryland law means nothing to me. However apparently the concept of an example is completely lost here.



> I have not studied the law, though, so I don't know if any of this is accurate;


Maybe you should. After all, "the instructor didn't tell me" doesn't fly as an excuse. Similarly, you're entering a supposed profession. Shouldn't you at least have a general understanding of the laws governing it? 




> You can come up with a million different examples of "what if you did something", and my answer will always be the same: 1. If I was preparing to do an action, then I was not actually doing the action. 2. If preparing to do the action is permitted, then preparing to do the action is not wrong; if preparing to do the action is not permitted, then preparing to do the action is wrong.


So, again, you don't believe in stopping bad actions until it's too late? 


So if you want a direct answer to your question, here it is. If I'm allowed to prepare an IV for the paramedic, and the IV is warranted in this situation, and I was doing everything correctly, then hopefully the kind, intelligent paramedic would appreciate my initiative. If I am not allowed to prepare an IV, or it wasn't warranted, or I was doing it wrong, then the paramedic would justifiably be concerned with my action. 




> I see a "ca.gov" in that link, and again, I'm not really interested in California law. It doesn't apply to me. Also, I don't typically follow links presented as an argument. I feel that if you want to make a point about something, then you should make it yourself, and not require me to go find your point for myself.



Apparently the concept of references and footnotes are lost on you too then. I provided the reference and linked to the source. Unlike you, I actually try to provide evidence for what I argue instead of "My instructor's cousin's friend's brother told me."


I am suggesting that unless someone is in imminent danger of doing something bad, then you should first take a moment to find out what it is, exactly, they are doing and why before you fire them for doing something they haven't actually done yet. If a guy is pointing a gun at a police officer, I feel the officer is justified in immediately shooting that guy for fear that the guy is about to shoot him. I don't think it's reasonable to expect the officer to first say, "Hey, I see you've got that gun there, and you're pointing it at me...Just wondering, you understand, if you're thinking about shooting me, 'cuz you know, I just need to know that before I can decide whether or not I'm going to have to shoot you first?" Now in the situation at hand, apparently, the OP was not found with an IV in his hand, millimeters away from the patient's skin and getting closer. He was found doing some preparatory actions. Was he trying to be helpful for the nurse? Was he really going to start the IV by himself? Some of you have already made up your mind, and sided with the nurse. I'm not that cynical. I don't know the guy so I don't automatically assume the worst of him. I think it would have been more appropriate for the nurse to ask him what he was doing and why, and either thanked him for his initiative, or warn him that even that much was outside his scope of practice.[/QUOTE]

I've made the argument that I can see where the facility is coming from. You have a person who has a history of impropriety regarding IVs. He's caught in the initial stages of starting an IV (palpating for a target). This is already well past where he should be if he was just helping to set up for an RN. If he finds anything, he's still going to have to remove the tourniquet anyways because a tourniquet isn't something to just be left in place. The RN is still going to have to do his/her own search for a vein. Would you rather just have the RN sit outside watching and waiting? How long should the RN wait?


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## Veneficus (Sep 21, 2010)

Jeremy89 said:


> There is nothing wrong with "looking for veins".  That doesn't mean that I was "in the process of starting an IV"- I could have drawn the blood without RN delegation, or I could have been looking for veins, *in the event that the patient goes downhill quickly, I could say "hey, his R AC feels great". * The physician DID order it so I knew either way it was getting started, either by me or the RN.



Can I just ask: Do you really think a skilled practicioner needs such help?




Jeremy89 said:


> My job as an ED tech was to anticipate what was going to happen and to prepare items for procedures or whatnot- if a patient is short of breath and their Sats are dropping, I'll grab the code cart just as a precaution, should we need to RSI.  If a nurse gets Propofol out of the Pyxis, I need to make sure a pump is in the room.  If we're taking a vented pt up to the unit, I need to ensure there is adequate O2 and a BVM on the bed. * I knew this specific patient was getting an IV so I chose to prepare all the items for whomever was to start it*..



But the second you went from goforing equipment to applying said equipment to the patient, you were no longer "just fetching supplies." 





Jeremy89 said:


> 3. With regards to my training, it was very very vague- we discussed general IV insertion and put a 22ga in a fake arm and we were done.  They didn't specify anything except we could only draw blood from the line when it was started and that we would not be giving any fluids other than the NS pre-filled flush at the time of insertion.  The instructor said "Any RN can sign you off", thus explaining my previous warning.  The other time when the RN asked me to switch over the line, I obviously said yes. * I figured if the RN was asking me then it was within my scope.[/*QUOTE]
> 
> It is always your responsibility to know your scope. Every person in the hospital has a clearly defined scope. There are authorities in nursing above those in your department. In the event you did not receive a satisfactory answer, you need to pursue the matter until you get a clear answer. Even if it is one you don't like.
> 
> ...


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## JJR512 (Sep 21, 2010)

JPINFV said:


> I know it's illegal, that's why I said it was illegal.
> 
> The second one is against facility policy (albeit not illegal), just like looking like you're going to start an IV is against the OP's facility policy.


Can you please provide the evidence in this thread that allows you to state as a fact that the facility in question (where the OP just got fired) has a policy against "looking like you're going to start an IV"? 



> ...and Maryland law means nothing to me. However apparently the concept of an example is completely lost here.


I've provided my own examples, and you think I don't understand the concept of examples? Really? Anyway, what you said didn't seem like an example to me; it seemed more like a counterpoint to what I was saying about Maryland law.



> Maybe you should. After all, "the instructor didn't tell me" doesn't fly as an excuse. Similarly, you're entering a supposed profession. Shouldn't you at least have a general understanding of the laws governing it?


Please note that I was talking about what the instructor _did_ tell me, not what he _didn't_ tell me. We are taught about the law when it is relevant to do so, and if I feel I understand what I read in the assigned book and what was gone over in class, then I typically don't feel the need to do additional research for the sole purpose of verifying what I just learned. I often do additional research when I wish to learn more, however, and that happens a lot.



> So, again, you don't believe in stopping bad actions until it's too late?


First of all, you can't stop a bad action when it's too late. When it's too late, the action is already done, and you can't stop something from happening in the past. More to the point of what I suspect you meant by your question, though, all I can say is I already answered that, and if you felt the need to ask again, then you _really_ need to improve your reading comprehension skills, because what you seem to have gotten out of what I said isn't even close to what I actually said.



> Apparently the concept of references and footnotes are lost on you too then. I provided the reference and linked to the source. Unlike you, I actually try to provide evidence for what I argue instead of "My instructor's cousin's friend's brother told me."


There are no references, footnotes, or links to what I'm arguing, because I'm arguing my opinion. I can't link you to my brain.

"My instructor's cousin's friend's brother told me." Where did that come from? I've talked about what my instructor said in one specific example. Do you think what you said is the same thing? Are you saying that I'm so stupid that I'd take whatever my instructor's friend's brother says with the same weight as what my instructor says? Really, if that's what you're saying, I'd like to know, because I'll have a few choice words for you if that's the case.



> I've made the argument that I can see where the facility is coming from. You have a person who has a history of impropriety regarding IVs. He's caught in the initial stages of starting an IV (palpating for a target). This is already well past where he should be if he was just helping to set up for an RN. If he finds anything, he's still going to have to remove the tourniquet anyways because a tourniquet isn't something to just be left in place. The RN is still going to have to do his/her own search for a vein. Would you rather just have the RN sit outside watching and waiting? How long should the RN wait?


No, the RN should not sit outside and wait. Don't be stupid. We're talking about an ER here, so sitting and waiting is rarely the right approach. Another reason why the nurse should not wait is because, as you said, the tourniquet can only stay in place for so long. I don't know if the OP had reason to expect that the RN would be returning imminently, or was actually unaware that the tourniquet couldn't stay there for long, or what. Maybe the OP thought the RN would be back right away, so there would've been no need to remove the tourniquet. I am willing to assume that the OP had reasons for doing what he did, reasons that made sense to him based on his experience, but I am _not_ willing to assume, as you are, that his reasons were _bad_.

I don't believe that what he was doing was wrong. He said he's done it before, including for this same particular nurse that got him fired this time, and had no trouble. So either what he was doing wasn't wrong, or it was, but for some reason it wasn't enforced until this time. What's different between all the other times and this time? I really don't know. What my core point here is, though, is that the RN got the guy fired because of what he (the RN) thought the OP was about to do, without ever actually bothering to try to find out what the OP was doing or why he was doing it. To me, that's a false accusation, and false accusations are something I refuse to idly let go by, even when it's done to someone else.


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## bstone (Sep 21, 2010)

Jeremy, listen buddy, they had it out for you. The RN was being evil and got you on a minor technicality, at best. Best idea: move on. Find another job. And one day be that RN's boss.


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## Veneficus (Sep 21, 2010)

Jeremy89 said:


> See my above post- it was delegated by the RN..



So what, if the RN erroneously delegated it to you it is your responsibility to tell her.
(along the same lines as having a duty to disobey an unlawful order)

If the nurse asked you to RSI the patient does it make it ok to do so because she asked you to?

I really encourage you to reflect on the whole "it is not my fault, I should not be responsible for my decisions" point of view. 



Jeremy89 said:


> Obviously you don't work in an ED...



Easy killer, I have worked in EDs longer than you have been in nursing school. One of my former ED employs credits itself as being among the busiest in the US.



Jeremy89 said:


> Its all about anticipation- the guy had symptomatic bradycardia.  Who knows if or when is AV node would stop firing?  Like I said, the RN was busy with his other 2 pt's (since he didn't let techs help him out- the whole purpose of our extended skills).  I wanted to stay with the patient until the RN came in, should anything happen.  But I wasn't just going to stand there when I could be doing something productive.



I am really trying to help you see the problem. 

What if the guy came in with acute appendicitis, were you just going to find McBurney's point, make a quick incision and get rid of the offender in the event he started to go south and the surgeon was already busy?

That would certainly be productive, and as crazy as it sounds, it is almost the same behavior as you attest to. 

Do you think if you had the guy drapped, and were looking for landmarks anybody would somehow not be alarmed because you did not yet have a knife in your hand? Would it be more alarming if you were twice counciled for not knowing your limits?  




Jeremy89 said:


> Exactly, but it couldn't hurt to look in the rare case that RN would let me start one (he did once- I was shocked).  I have learned to anticipate the size and location of the IV- this guy very well could get a CT Angio Chest so he'd need an 18+ in the AC.



Not quite so simple. A sin of not knowing what you don't know. The reason many places require a 20 or larger iv for contrast is because of the tested flow rate of the teflon catheter. 

The smaller lines can be used, they are just not rated for it specifically so if nothing else can be established and the IV contrast needs to be done, a physician can sign off on using the smaller catheter. 

"We could play what if" games back and forth all night, but I have a very long list of "what ifs."



Jeremy89 said:


> I can't stand working under my education level.



You might want to dwell on that for a while. There are many people who work under their educational level, and whether they like it or not is inconsequential. 

When in Rome, do as the Romans do.

Denying responsibility, and assigned extrinsic blame is really not the best way to learn from this experience.


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## EMS49393 (Sep 21, 2010)

JJR512 said:


> Preparing to start an IV is not the same as starting an IV. The OP was fired for doing something that he was only preparing to do, not actually doing.
> 
> If I'm putting toothpaste on my toothbrush, I'm preparing to brush my teeth, but I'm not brushing my teeth. If I'm getting in a car, putting on my seatbelt, and getting out my keys, I'm preparing to drive the car, but I'm not driving the car.
> 
> ...



WRONG!  You do not even have a license as an EMT-B in Maryland.  You have a certification.  You will have a license if you continue with your education and become at least an EMT-I.  Only ALS providers have licenses in Maryland.  All EMS providers in Maryland are technically functioning under the guidelines set forth by MIEMSS, Dr. Alcorta, and Dr. Bass, as well as their own jurisdictional program medical director.  

In regards to the OP.  Before you do ANY thing to a patient, especially something invasive, it's generally best to clarify exactly what you are allowed to do.  I would imagine a big hospital system has someone somewhere that can give you an accurate job description and clarify any procedures you are allowed to preform.

IV's are not some benign procedure that anyone should be allowed to preform, especially with such limited training.  There are a lot of complications associated with IV therapy, and although they are rare, you need to be able to ANTICIPATE them occurring and be able to react appropriately.  Just for instance, do you know what dangers a sheared catheter can present?   

I've been a paramedic for a while.  I took a part time job as an ER tech a few years ago for some extra cash, and because I really liked the interim director.  Although I was a paramedic and could do all these awesome and totally radical things  on the ambulance by myself, I was more or less an EKG tech, phlebotomist, bed changer, and linen stocker in the ER.  A few times I had a physician (who happened to be my EMS medical director) give me a direct order to insert an EJ, give code drugs, or record for major medicals or traumas.  I clarified those order every time and also made sure that the physician knew that was out of my ER tech scope.  Because I had specific orders, I was covered, but I always CLARIFIED, and he always documented that he ordered the tech who was otherwise licensed as a paramedic to preform the procedure.  

It's your job to make sure you know EXACTLY what you are and are not allowed to do.  The excuse "I didn't know" is just that, an excuse.  You're an adult, cover your own butt, take care of yourself, and know your boundaries.


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## JPINFV (Sep 21, 2010)

JJR512 said:


> Can you please provide the evidence in this thread that allows you to state as a fact that the facility in question (where the OP just got fired) has a policy against "looking like you're going to start an IV"?


Can you show me where they had a policy allowing it?



> I've provided my own examples, and you think I don't understand the concept of examples? Really? Anyway, what you said didn't seem like an example to me; it seemed more like a counterpoint to what I was saying about Maryland law.



Your example was you were told something in class that doesn't jive with the tradition extension of a scope of practice to students in educational environments. My counter example was a law pointing to where that was allowed in another state and the fact that Maryland code online is a pain in the butt.

Oh, by the way, here's the parts of Maryland Code that most directly reference clinical scope of practice. The thing that looks like a web address. That's called a reference for the section immediately above it.



> 30.04.03.04
> A. Each BLS education program shall maintain accurate and appropriate records of:
> ...
> (4) Written agreements with facilities and agencies providing clinical and field experience which include:
> ...


http://www.dsd.state.md.us/comar/comarhtml/30/30.04.03.04.htm



> 30.04.03.05
> B. Each BLS education program shall provide:
> 
> (1) Didactic instruction which shall impart fundamental knowledge, skills, and attitudes which contribute to the delivery of state-of-the-art prehospital emergency medical care including:
> ...


http://www.dsd.state.md.us/comar/comarhtml/30/30.04.03.04.htm

So apparently your instructor did lie to you in a way. It's not the law limiting your initial scope of practice, it's the agreement between your school and the clinical site. 




> Please note that I was talking about what the instructor _did_ tell me, not what he _didn't_ tell me. We are taught about the law when it is relevant to do so, and if I feel I understand what I read in the assigned book and what was gone over in class, then I typically don't feel the need to do additional research for the sole purpose of verifying what I just learned. I often do additional research when I wish to learn more, however, and that happens a lot.


What part of the law is not relevant to you? Was your assigned book specific to Maryland or just a basic EMS text book?



> First of all, you can't stop a bad action when it's too late. When it's too late, the action is already done, and you can't stop something from happening in the past. More to the point of what I suspect you meant by your question, though, all I can say is I already answered that, and if you felt the need to ask again, then you _really_ need to improve your reading comprehension skills, because what you seem to have gotten out of what I said isn't even close to what I actually said.



However, if you recognize something bad happening you can very much preempt it. If I see a man raise his hand to beat his wife, I can take affirmative action to protect his wife. I don't have to wait for him to beat the crud out of her first. If someone breaks into my house in the middle of the night and I have a reasonable fear that he has the capability to case significant bodily harm or death to someone in my house or me (and robbery is specifically mentioned as being a "forcible and life threatening crime"), I don't have to wait for him to brandish a weapon. In California I have an affirmative defense to take his life. I don't have to wait for him to harm someone before I discharge my Winchester. 

Another reference: http://ag.ca.gov/firearms/forms/pdf/Cfl2007.pdf bottom of PDF page 32.




> There are no references, footnotes, or links to what I'm arguing, because I'm arguing my opinion. I can't link you to my brain.


Next time you have to write a paper for school, try arguing that you don't have to use resources to argue your side. No really, please do. 

Besides that, you missed what I was talking about. I was referencing the fact that you were complaining that I had a link in my own footnote referencing a quote in my own footnote. So apparently, in addition to your own statement, you fail to understand how a footnote is used when someone else is using them as well. 



> "My instructor's cousin's friend's brother told me." Where did that come from? I've talked about what my instructor said in one specific example. Do you think what you said is the same thing? Are you saying that I'm so stupid that I'd take whatever my instructor's friend's brother says with the same weight as what my instructor says? Really, if that's what you're saying, I'd like to know, because I'll have a few choice words for you if that's the case.


...and, as provided above with an actual reference, it's misleading at best, a flat out lie at worse to say that Maryland Law was restricting what you can do during initial clinical experiences. Taking what someone says at face value when it is easily referenced is no different than taking your instructor's cousin's best friend's brother's opinion. There's absolutely zero reason to not verify something so easy. 



> No, the RN should not sit outside and wait. Don't be stupid. We're talking about an ER here, so sitting and waiting is rarely the right approach.


...but if the RN has reason to believe that there's some sort of impropriety going on, he/she should just trust the person engaged in the impropriety? "No, seriously officer, it was the other man dressed like me that robbed that house!"



> Another reason why the nurse should not wait is because, as you said, the tourniquet can only stay in place for so long. I don't know if the OP had reason to expect that the RN would be returning imminently, or was actually unaware that the tourniquet couldn't stay there for long, or what.


...which, of course, could play into why things went down like they went down.


> Maybe the OP thought the RN would be back right away, so there would've been no need to remove the tourniquet. I am willing to assume that the OP had reasons for doing what he did, reasons that made sense to him based on his experience, but I am _not_ willing to assume, as you are, that his reasons were _bad_.


Really? Where did I say his reasons were bad? Should I reference where I discussed how I could see how it could be viewed as bad? Want me to reference where I mentioned that having prior strikes definitely didn't help his case? Oh, sorry, there's that word, "reference" again. Guess not. 



> I don't believe that what he was doing was wrong. He said he's done it before, including for this same particular nurse that got him fired this time, and had no trouble. So either what he was doing wasn't wrong, or it was, but for some reason it wasn't enforced until this time. What's different between all the other times and this time? I really don't know. What my core point here is, though, is that the RN got the guy fired because of what he (the RN) thought the OP was about to do, without ever actually bothering to try to find out what the OP was doing or why he was doing it. To me, that's a false accusation, and false accusations are something I refuse to idly let go by, even when it's done to someone else.



So, apparently his story alone isn't enough to see how his superiors thought he was wrong, but it's enough to exonerate him?


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## Hellsbells (Sep 21, 2010)

> I was picking up hours in the EKG department and got called up for a Rapid Response. When the patient coded I wasn't just gonna sit there and watch these MedSurg nurses fumble around the code cart when I know it inside and out. *Besides, its not like the patient needed an EKG* while he was coding!! Might as well make myself useful.



I would say, that with the exeption of CPR, an EKG on a code (particularly a witnessed arrest) is the most useful intervention available. I don't know if the quick combo pads were on yet, but knowing if the patient is on a shockable rhythm or not is critical.


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## Jeremy89 (Sep 22, 2010)

Hellsbells said:


> I would say, that with the exeption of CPR, an EKG on a code (particularly a witnessed arrest) is the most useful intervention available. I don't know if the quick combo pads were on yet, but knowing if the patient is on a shockable rhythm or not is critical.



Sorry, I should have specified. I was doing 12-leads.  The pt was hooked up to the monitor/defib while CPR was in progress.


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## Akulahawk (Sep 22, 2010)

Perception IS reality. Every time I put on the uniform and hop on the ambulance, I "dumb down" the things that I can do. When it comes to certain types of injuries, *I* am the guy you want to see, if I am off-duty. Why? I can very accurately determine what's wrong, start you down a path that can limit further damage and complications from that injury, and tell you the correct specialist you'll need to see to correct it. While many advanced practitioners do get educated in how to do those same evaluations, while they may see a few patients with a given problem, I likely have seen several times more than that. 

Now when I am "on-duty", I can NOT do those things. While I can document the depth of education that I have, there is NO way I can defend exceeding my authorized Scope of Practice while I am on-duty. So I do the absolute MOST that I can do without exceeding my authorized SOP and without appearing like I am about to either.


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## Akulahawk (Sep 22, 2010)

What was the point of my story above? Simple. While I have a VERY good education that provides me with a level of expertise that a LOT of people involved in medicine don't have (true only within that specific field), I very often must work well below that.

Know your authorized scope of practice for every place you work. Know it, love it, worship it if you must. If you exceed it, your professional life can go from OK (pretty decent really) to TARFU to FUBAR before you even know what you did wrong. 

While Physicians have an "Unlimited License to Practice Medicine" the facility they work for may say "you can't do this..." and if that Physician goes ahead and does it anyway, that Physician might just find his or her backside no longer employed there.


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## JJR512 (Sep 22, 2010)

EMS49393 said:


> WRONG!  You do not even have a license as an EMT-B in Maryland.  You have a certification.  You will have a license if you continue with your education and become at least an EMT-I.  Only ALS providers have licenses in Maryland.  All EMS providers in Maryland are technically functioning under the guidelines set forth by MIEMSS, Dr. Alcorta, and Dr. Bass, as well as their own jurisdictional program medical director.



What's with all the censored stuff in what you quoted from me?

Anyway, I already know everything else you said at me. I'm sure the instructor was speaking generically. I have no doubt that regardless of the exact legal terminology, the instructor was correct in simple terms that at this point in the course I am not yet authorized for patient contact, and having patient contact makes me guilty of _something_.


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## JJR512 (Sep 22, 2010)

JPINFV said:


> Can you show me where they had a policy allowing it?


No, I cannot, because that information is not definitively provided here, and since it is not, I, unlike you, will not make any assumptions about it one way or the other.



> Your example was you were told something in class that doesn't jive with the tradition extension of a scope of practice to students in educational environments. My counter example was a law pointing to where that was allowed in another state and the fact that Maryland code online is a pain in the butt.
> 
> Oh, by the way, here's the parts of Maryland Code that most directly reference clinical scope of practice. The thing that looks like a web address. That's called a reference for the section immediately above it.


Oh, is THAT what a reference is? Hey pal, take your attitude and shove it up your ***, OK? Thanks!



> So apparently your instructor did lie to you in a way. It's not the law limiting your initial scope of practice, it's the agreement between your school and the clinical site.


No. Nothing you quoted contradicts what I said. (In case you've forgotten: "My understanding of Maryland law is that until we have been trained to a minimum standard, patient contact is not allowed. The minimum standard is completion of Mod 3, by which time we have been trained in patient assessment, which during our field internships, is really the only thing we're supposed to be doing.") I already said that we do field internships. What I also said is that we are not allowed to begin the field internships until we have been taught the relevant skills in the classroom, and that makes perfect sense to me. It would be stupid to be allowed to go out in the field and attempt to practice the full scope of practice, even with supervision, before being taught a damn thing about it.



> What part of the law is not relevant to you? Was your assigned book specific to Maryland or just a basic EMS text book?


Ask a stupid question, get a stupid answer: Almost _all_ of the law is not relevant to what is being taught in EMT-B class. In other words, any law (or statute, regulation, code, ordinance, etc.) that has nothing to do with what an EMT-B can or can't do is not relevant to me, not to _me_ in the specific sense of a person sitting in an EMT-B class being taught how to be an EMT-B.

However, as I said (and as you quoted me saying), when there _is_ a law that applies to what we're being taught, that law is usually taught as well, or at least mentioned.



> However, if you recognize something bad happening you can very much preempt it. If I see a man raise his hand to beat his wife, I can take affirmative action to protect his wife. I don't have to wait for him to beat the crud out of her first. If someone breaks into my house in the middle of the night and I have a reasonable fear that he has the capability to case significant bodily harm or death to someone in my house or me (and robbery is specifically mentioned as being a "forcible and life threatening crime"), I don't have to wait for him to brandish a weapon. In California I have an affirmative defense to take his life. I don't have to wait for him to harm someone before I discharge my Winchester.


You are talking about preventing something that is in immediate danger of happening. As I already said, I have no problem with that. In my opinion, feeling for a vein does not constitute a patient being in immediate danger of having his arm stuck by an unauthorized person. Holding the IV, even reaching for the IV, might constitute that danger, but the OP hadn't gotten to that point yet.



> Next time you have to write a paper for school, try arguing that you don't have to use resources to argue your side. No really, please do.


What does writing a paper for school have to do with what's going on here? Here I'm just presenting my opinion. My opinion in this case comes entirely from my own mind. It is not based on any resources from outside of this thread, therefore I have no need of references or footnotes. Writing a paper for school is very, very different. Obviously a scientific, research, or other fact-based paper would include many references. Even an argumentative essay might include some. I'm not going into that level of detail here (and one reason is that there isn't really much to go on). 



> Besides that, you missed what I was talking about. I was referencing the fact that you were complaining that I had a link in my own footnote referencing a quote in my own footnote. So apparently, in addition to your own statement, you fail to understand how a footnote is used when someone else is using them as well.


I "fail to understand how a footnote is used when someone else is using them as well?" As well as what, or whom? You don't communicate very clearly. In any event, I wasn't complaining about a link in your footnote. My problem was that I failed to realize it was a footnote at all. I thought it was just some random link you threw in at the end for further reading. So I apologize for not realizing you were using footnotes; I'm just not used to seeing them in internet forums. I have no problem with providing a reference to where a quotation comes from; I usually do it myself (although not usually in footnote form in internet forums; I like to keep things simple and casual when there's no need for formal writing, but that's just me).



> ...and, as provided above with an actual reference, it's misleading at best, a flat out lie at worse to say that Maryland Law was restricting what you can do during initial clinical experiences. Taking what someone says at face value when it is easily referenced is no different than taking your instructor's cousin's best friend's brother's opinion. There's absolutely zero reason to not verify something so easy.


Let me just quickly remind you of something you said earlier:


> ...the fact that Maryland code online is a pain in the butt.


So which is it? Is Maryland code online a pain the butt as you said earlier, or is it "easily referenced" and verified "so easy"?

More to the real point, though, there _is_ a reason to not verify every single thing I'm taught in class. First of all, when I'm being taught something, I do have some faith that the teacher knows what he or she is talking about. Second, when the teacher teaches something that makes sense, I see no need to waste time on verifying it, especially when it makes no difference if the teacher is actually right or wrong. I said it before, and I say it again: Not being allowed to have patient contact from Day 1 makes sense to me. I believe it's perfectly reasonable for an EMT-B student to be restricted from patient contact until at least _some_ didactic knowledge has been imparted, the impartation being verified through testing. Since the point of the field internships is to practice patient assessment, it seems logical to me to wait until we've been taught about patient assessment in class before trying to do it in the field. It just makes sense, so why bother trying to research the law to see if he's right or wrong? And what am I going to do if I can't find a law that says, "You are practicing medicine without a license if you're an EMT-B student and you touch a patient before passing Mod 3?" Am I going to tell the instructor, "You're wrong, dumbass, nyah nyah!" Am I going to out that very night and start playing with all the toys on every patient I can find? No, of course not! So what difference does it make to me what exactly the law says? We're not being tested on that, and after completing the class it's no longer relevant.



> Really? Where did I say his reasons were bad? Should I reference where I discussed how I could see how it could be viewed as bad? Want me to reference where I mentioned that having prior strikes definitely didn't help his case? Oh, sorry, there's that word, "reference" again. Guess not.


If you make those two references you asked me if you should make, you would only serve to reinforce my opinion that you think his reasons were bad. So by all means, go ahead and make them.

And as for your implication that I don't know what "reference" means, as before, take it and shove it up your ***. Deep and hard, please. Failing to notice that part of one of your posts was a footnote does not mean I'm a retarded moron. I'm human, so I'm not perfect, but if you can't get past one mistake, then...deep and hard, please. Thanks. (I'd say a few other things, but it'd just get censored, so I won't waste any more time on you.)



> So, apparently his story alone isn't enough to see how his superiors thought he was wrong, but it's enough to exonerate him?


Oh, his story is more than enough to see that his superiors that he was wrong. That his superiors thought he was wrong was pretty much the point of his story, and one would have to be a retarded moron to not pick up on that fact...Oh, wait, you already think I am one, I forgot. One mistake equals stupidity in your book, got it. You make assumptions about me just as easily as you do about the OP.

Is his story alone enough to exonerate him? Well, I'm not sure. There isn't enough information in the story to convict him in a court of law, not beyond a reasonable doubt. Not with a competent judge, anyway, although going by the responses of some of the OP's peers here, he might have more trouble with a jury. I for one, though, try to avoid being overly judgmental when short on facts and information.


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## 8jimi8 (Sep 22, 2010)

LonghornMedic said:


> Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.



just stop,  you are wrong. we also operate under standing orders.  Just because we don't pick and choose which protocol to follow, doesn't mean we have a doctor over our shoulder telling us which way to look.  We do plenty based on protocol and standard of care.

you think if someone codes in front of me i'm going to be twiddling my thumbs waiting for a doctor to call back?  No, we operate based on protocols and standing orders.  If you aren't an RN, please don't limit us to what _you_ think we can do.


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## Veneficus (Sep 22, 2010)

8jimi8 said:


> If you aren't an RN, please don't limit us to what _you_ think we can do.



Does that mean you don't need someboy to help you find a vein to cannulate?


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## Shishkabob (Sep 22, 2010)

Veneficus said:


> Does that mean you don't need someboy to help you find a vein to cannulate?



Speaking from experience, some RNs definitely need to be told in which direction to stick the needle... h34r:


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## fortsmithman (Sep 22, 2010)

LonghornMedic said:


> Yeah, you're right. But a RN has to get orders every time they want to do anything. I don't. I have standing orders to do what I want when I see fit. I don't have to call an ER and ask for morphine. I can just do it. A RN can't.



RN's do have standing orders.  RN's have more medical education.


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## dixie_flatline (Sep 22, 2010)

JPINFV said:


> ...
> Second, what would the paramedics response be if you were alone with a patient for a few minutes while he went and did something (put something away outside, talk to a family member, what ever) and he came back to find you with an IV kit, a tourniquet around a patient's arm and palpating for a vein. After all, it's not illegal to assist with an IV, tie a tourniquet around the patient's arm, or feel for a vein.



Just a note - I hope that a paramedic wouldn't leave a trainee (or even a B ) alone with a patient for _*any*_ reason.  There is a whole mess of reasons why that's a Bad Thing.


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## JPINFV (Sep 22, 2010)

dixie_flatline said:


> Just a note - I hope that a paramedic wouldn't leave a trainee (or even a B ) alone with a patient for _*any*_ reason.  There is a whole mess of reasons why that's a Bad Thing.



Do you also subscribe to the theory that leaving the patient alone for 5 seconds is abandonment?


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## Shishkabob (Sep 22, 2010)

fortsmithman said:


> RN's do have standing orders.  RN's have more medical education.



I know I'll get heat for this, but that truly is debatable.



More generalized education in all aspects of health?  Sure.  More education period?  No.


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## dixie_flatline (Sep 22, 2010)

JPINFV said:


> Do you also subscribe to the theory that leaving the patient alone for 5 seconds is abandonment?


Calm down man, I was just trying to point out that leaving a trainee alone with a patient that requires IV therapy, long enough for said trainee to indulge his inner-Clooney, might be indicative of a more systemic problem.  Please don't bait-and-switch by comparing that with leaving a patient alone for 5 seconds.  However, if there's an ambulance chaser around, 5 seconds IS abandonment.

As for OP, I empathize, but I've been down that road before.  When I was fresh out of high school, I was hired by my school district to help the district's 2 computer guys over the summer (keep in mind computers in school were pretty new back then).  

At one point, I got written up because our boss told me to do Thing A.  Unfortunately, Thing A turned out to be thoroughly impossible, technically speaking.  I tried many different tricks, before doing the research and realizing it wouldn't ever work.  Being that my boss had left shortly after tasking me, and being that this was pre-cell phones, I re-joined the rest of my group and assisted them in their task of pulling wires, figuring that was more productive then banging my head against the wall in pursuit of a fruitless task.  I was written up for overstepping my boundaries or something along those lines.  

A month or two later, I was approached by one of the ladies who worked for the school district (who was herself not very pleasant).  She said she needed some big strong men to help her carry computers into the office.  As I followed her outside _to do exactly as she had asked_, I noted that if she was looking for big/strong men, she should probably keep looking - I was a cross country runner, 6'2" & 160lbs soaking wet, able to bench press somewhere in the neighborhood of 50lbs.  She complained that I was insubordinate and I was fired on the spot.  Oh, also that day was my 19th birthday.

The guy who fired me ended up getting arrested a few years later for having a Tony Montana-like coke habit, so I guess there's that.

The point of this silly reminiscence is to note that as a subordinate employee, it isn't really for you to decide what is beneath you.  I was in college at the time as a freshman studying Information Systems and I already had more experience/knowledge than the guys who were my bosses.  Yeah, it bugged me, and in my opinion my firing was pretty harsh, but it was their prerogative.


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## Veneficus (Sep 22, 2010)

dixie_flatline said:


> Please don't bait-and-switch by comparing that with leaving a patient alone for 5 seconds.  However, if there's an ambulance chaser around, 5 seconds IS abandonment..



I think thay may be an extreme example. Perhaps even boardering on paranoid. 

The most important aspect of abandonment is the intent to discontinue treatment. 

Even that has considerable caviats to it. 

For example, it would be impossible to turf a call to BLS, if such literal interpretation were applied,  everytime a paramedic made any patient contact, they would be obligated to continue care until another provider could be found. 

It would be difficult if not impossible to care for multiple patients at once. 

Even then, reasonable danger to the provider is an acceptable circumstance to leave a patient. 

There is also often the need to fetch equipment or other tasks associated with care.


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## FLEMTP (Sep 22, 2010)

Linuss said:


> Just because I want to beat jp to thee punch....
> 
> Protocols ARE orders.



So what if you dont even work under protocols?

Our agency doesn't. We have medical guidelines, but we are told to do what needs to be done for the patient, as long as its accepted medical practice, or we can defend our actions with sound reasoning, then we are in the clear!

I guess our standing orders are: there are no standing orders. do what you wish!


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## 8jimi8 (Sep 22, 2010)

Veneficus said:


> Does that mean you don't need someboy to help you find a vein to cannulate?



So I came upon a scene with 2 paramedics who had just inserted an EJ.  I asked them if they knew what hydrocephalus was.  When they looked at me sideways I said,  "you are bolus'ing his brain.


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## JJR512 (Sep 22, 2010)

dixie_flatline said:


> Just a note - I hope that a paramedic wouldn't leave a trainee (or even a B ) alone with a patient for _*any*_ reason.  There is a whole mess of reasons why that's a Bad Thing.



Is this statement absolute—a paramedic should not ever leave any patient alone with an EMT-B, period, regardless of the patient's condition or the circumstances, period? That's how it reads here. But I am aware that later you said you were just..."trying to point out that leaving a trainee alone with a patient that requires IV therapy"...is the Bad Thing.

I just wanted clarification on what you meant, because if you meant it in the absolute sense, well I'd have a problem with that. Not ever patient an ALS provider comes to requires ALS care. As *Veneficus* ponders, is it abandonment if an ALS provider leaves a BLS patient alone with a BLS patient? I know of Paramedic/EMT-B teams that work well together, and sometimes even with ALS patients that -B might get left alone for a moment with the patient. But that's a team of people that have worked together and work well together, and they know and trust each other.

So all I'm saying here is that I don't like the absolute way in which you phrased what I quoted. There are always exceptions that can be found.


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## Shishkabob (Sep 22, 2010)

FLEMTP said:


> So what if you dont even work under protocols?
> 
> Our agency doesn't. We have medical guidelines, but we are told to do what needs to be done for the patient, as long as its accepted medical practice, or we can defend our actions with sound reasoning, then we are in the clear!
> 
> I guess our standing orders are: there are no standing orders. do what you wish!



Within all reason of course. Legally, protocols ARE our orders. Realistically, at least at your and my service, they don't have to be followed step by step and of course it's best judgement. 


But I also know of no medic who's going to drill in to a brain to alleviate pressure...


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## JPINFV (Sep 22, 2010)

FLEMTP said:


> We have medical guidelines,



Since not everyone with protocols are expected to consider the protocols cookbooks to be followed to the T, is there a difference between the specific noun used?


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## Lifeguards For Life (Sep 22, 2010)

FLEMTP said:


> So what if you dont even work under protocols?
> 
> I guess our standing orders are: there are no standing orders.


I have heard those exact words come from our medical directors mouth.


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## uberowen (Sep 22, 2010)

I feel like I'm reading an EMT Daytime Soap Opera with all the arguing going on in here.


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## firetender (Sep 22, 2010)

*Three strikes you're out. 2 down, bottom of the 9th.*



Jeremy89 said:


> *As a nursing major, I couldn't stand working as a "dumbed down" tech who wasn't allowed to share and utilize what I knew.*



And THAT is precisely what you also KNEW they were watching.



Jeremy89 said:


> I was _*warned *_previously...Once I had an MD put a syringe of Viscous Lidocaine on the table while I put a foley in..._*its just lidocaine, right*_? ... "in the grey area"..._*I assumed *_it was within my scope.  _*Maybe its my fault for not knowing my scope*_...the date of my second warning was in April...all was good for over 3 months...(and wasn't even "bad" when I got fired- *I didn't do anything out of my scope*).



Outside of your obvious contradiction and, C'mon, Jeremy, get real; you were holding a gun in your hand and pulling back it's hammer; what does that look like to an RN you KNOW who's watching your every move? J

You are a smart person. And slick, too (and not in a bad way at all!). In their eyes, you were getting ahead of yourself and them. To you, it was all about using what you know, not at all unreasonable. Unfortunately, to them it appeared dangerous. My money's on your presentation, as reflected in the first quote above, didn't help. You thought you were smart enough to get over, but three months wasn't long enough to allay their mistrust of you. 

_*Sorry, you drew a Bullseye on your butt and got caught with your hand in the cookie jar while pushing the edge of the envelope and as a result, you screwed the pooch.*_

(Gimme a minute, I know there are more cliches to use here!)

Accept it. There doesn't appear to be damage done to your career movement. Get placed somewhere else and NOW and use this as a lesson in humility.

Love,
your freindly firetender


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## dixie_flatline (Sep 22, 2010)

JJR512 said:


> Is this statement absolute—a paramedic should not ever leave any patient alone with an EMT-B, period, regardless of the patient's condition or the circumstances, period? That's how it reads here. But I am aware that later you said you were just..."trying to point out that leaving a trainee alone with a patient that requires IV therapy"...is the Bad Thing.
> ....
> So all I'm saying here is that I don't like the absolute way in which you phrased what I quoted. There are always exceptions that can be found.



Everything has an exception; this is definitely not an absolute.  I know some EMS professionals who would say otherwise, but going to the box to get something is generally not a problem re: Abandonment.  It really kind of depends on the state of the patient, how long the absence is, and a little bit of luck (if you leave what you thought was a stable pt and it takes you 1 minute to fetch something and you come back to a coded pt, well...).  And turfing a BLS call down to an EMT is fine, provided the correct procedures are followed for the hand-off.

I was just pointing it out because of how the situation was described.  If I heard about a medic who was precepting or otherwise responsible for a student, who left that trainee alone with the pt and this happened, I'd have a few questions is all - some for the trainee applying a tourniquet and palpating, but mostly for the medic who is in charge of the scene and the pt.

I don't think there's any more need to discuss abandonment or my earlier comment though.  It's water under the bridge and it's not adding to OP's discussion.


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## FLEMTP (Sep 22, 2010)

Linuss said:


> But I also know of no medic who's going to drill in to a brain to alleviate pressure...




But... isnt that why the EZ-IO was invented?  I prefer to use the "obese" patient drivers to do a craniotomy btw... B)


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## ShannahQuilts (Sep 22, 2010)

I know it's tough to lose your job, and I have seen a lot of really great comments in this long argument.  

In the end, though, I think you are really missing a couple of the most important points: 1) you weren't focusing on being part of your team, and 2) you aren't taking responsibility for your own actions.  

You didn't want to work below your skill level; you think 3 months is a long time and that you'd shown you could be trusted.  You have also argued that you were right to do what you did.

If you were right, why don't they want you back?  Could it be because you decided that it was more important to you to do every bit of work you felt you were capable of doing, than it was to get along with the other staff and not overstep your bounds?

You don't have to answer this on the forum, but you might want to consider: how many of your former co-workers were willing to talk to personnel on your behalf, and/or how many are willing to give you a reference for a new job?

If the answers are zero and zero, the day will come, eventually, when you look back and realize you have nobody to blame but yourself, and that what you did was to exhibit poor judgment.  

Trying to justify it by splitting hairs doesn't change the situation.


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## EMS49393 (Sep 22, 2010)

ShannahQuilts said:


> I know it's tough to lose your job, and I have seen a lot of really great comments in this long argument.
> 
> In the end, though, I think you are really missing a couple of the most important points: 1) you weren't focusing on being part of your team, and 2) you aren't taking responsibility for your own actions.
> 
> ...



Where is the clapping hands icon?  That is undoubtedly the best post within an EMS forum that I have come across in weeks, perhaps months.   Nice summary.


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## Jeremy89 (Sep 23, 2010)

ShannahQuilts said:


> I know it's tough to lose your job, and I have seen a lot of really great comments in this long argument.
> 
> In the end, though, I think you are really missing a couple of the most important points: 1) you weren't focusing on being part of your team, and 2) you aren't taking responsibility for your own actions.
> 
> ...



How was I not being part of the team?  I wasn't just going to leave a pt lying in bed with a 2nd degree AV block and I wanted to make sure the primary nurse knew he was in there.

Like I mentioned before, I didn't need a nurse's delegation to draw the blood, but typically we communicate with the nurses to get the blood so the pt doesn't get poked more than once.  I heard the MD loud and clear (though I wasn't allowed to take a verbal order- I would have checked the computer to be sure) that they needed stat labs sent on him.

There is no harm in looking for veins, especially if the nurse would've let me start the line- I woulda been 2 steps ahead already.

As to references, the day I got fired I told a few of the RN's I was working with.  I got _at least_ 6 that told me I could contact them for references or if I needed anything just that day- more by email later.  I discussed the problems I was having with that particular nurse.  One of the other nurses said "I love him outside of work, but here I can't stand him" and I know other nurses felt the same way. Just a testament to his character at the workplace.


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## Veneficus (Sep 23, 2010)

Jeremy89 said:


> How was I not being part of the team?  I wasn't just going to leave a pt lying in bed with a 2nd degree AV block and I wanted to make sure the primary nurse knew he was in there.
> 
> Like I mentioned before, I didn't need a nurse's delegation to draw the blood, but typically we communicate with the nurses to get the blood so the pt doesn't get poked more than once.  I heard the MD loud and clear (though I wasn't allowed to take a verbal order- I would have checked the computer to be sure) that they needed stat labs sent on him.
> 
> ...



Autonomy without responsibility or liability.

...The dream of healthcare providers everywhere.

I am very entertained by this story, it keeps getting better and better.


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## medicRob (Sep 23, 2010)

I have watched this thread and have held my tongue, but as a Registered Nurse, I feel it necessary to weigh in. 


It is YOUR responsibility to know your scope of practice. You were already in trouble, don't try to blame everyone else for your actions. We see it here all the time on this forum, people come in with, "I hate my Partner" or "My Job sucks" when it is usually the individual in question that is the issue, but instead of looking at their own actions and asking if they are perhaps the problem, they choose to blame someone else. 

When an MD orders something in an ER setting, it is up to the RN or another physician to delegate who does what. If the MD did not tell you specifically to start an IV, you wait until you are told or you ask someone if they would like you to start it. It seems to me like you were just itching to stick somebody, so instead of asking the RN (WHO YOU KNEW WOULD TELL YOU "NO"), you went ahead and "prepped" the patient. YOU ARE AT FAULT. 

Also, your comment about, *"As a nursing major, I couldn't stand working as a "dumbed down" tech who wasn't allowed to share and utilize what I knew.*"

Nursing major doesnt mean $h!t if you are working in the capacity of a tech. You are under the delusion that you being a nursing student actually means something with regard to your scope of practice. Son, you are not an RN until you take the NCLEX and you get your license. Don't get it twisted.

Don't start with the, "When Im on clinicals" BS either. The fact is at the time you were in the capacity as an "ER Tech", not an RN Student. I am a Nurse Practitioner student, but do you think I am going to try to write a prescription for my patient without a certificate of fitness? 

I see your type in my practice every day. You think that because you are a nursing student that you are somehow better than the average tech or that you are magically given an extended scope of practice. Even when you finish your RN license, you are going to be under an RN for a year while being trained. 

Bottom Line:

You were warned, you didn't listen. You got fired, and you deserved to be fired. 

If you were a nursing student on clinical rotations with me in the trauma unit or the ICU, I would fail you for the day for that crap. 

/Thread


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## Shishkabob (Sep 23, 2010)

Which brings up the whole BoN pushing their weight around to get things enacted that make THEM the only ones seen as "licensed" practitioners in the hospital setting when compared to other health professionals like Paramedics....


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## medicRob (Sep 23, 2010)

Linuss said:


> Which brings up the whole BoN pushing their weight around to get things enacted that make THEM the only ones seen as "licensed" practitioners in the hospital setting when compared to other health professionals like Paramedics....



I wasn't necessarily speaking about Paramedics Linuss. I was thinking more along the lines of a CNA working as an ER Tech, or in this guy's case an EMT-B.


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## TransportJockey (Sep 23, 2010)

Linuss said:


> Which brings up the whole BoN pushing their weight around to get things enacted that make THEM the only ones seen as "licensed" practitioners in the hospital setting when compared to other health professionals like Paramedics....



Linuss, most hospitals do not regard EMTs or medics as 'licensed' staff when their job title is not EMT or Paramedic. And a lot of time when you are working as a tech, your job title is the only thing that determines your scope of practice. The ED medical director is telling you what you are limited to, and could care less if you can do more somewhere else. Just the way a hospital works.


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## dixie_flatline (Sep 23, 2010)

medicRob said:


> I have watched this thread and have held my tongue, but as a Registered Nurse, I feel it necessary to weigh in.
> 
> 
> It is YOUR responsibility to know your scope of practice. You were already in trouble, don't try to blame everyone else for your actions. We see it here all the time on this forum, people come in with, "I hate my Partner" or "My Job sucks" when it is usually the individual in question that is the issue, but instead of looking at their own actions and asking if they are perhaps the problem, they choose to blame someone else.
> ...


This sums it up pretty well.  It sounds a little harsh, but OP doesn't seem to be acknowledging any fault.  The bottom line is that any extra knowledge you might have means nothing when you are hired to do a certain job.  Going back to the example I posted about my only experience getting fired - they weren't interested in me being a self-starter or taking the initiative.  Those are not always good qualities.  Especially in a setting like an ED, the staff would much rather have a predictable, reliable cog who fits well into the madness and does _what they are supposed to do_, _when they are supposed to do it_.  Some jobs applaud risk-taking, pushing boundaries, etc - but those are usually jobs measured in dollars, not deaths.

The only time you should be busting out skills you aren't licensed/delegated/paid to do is when the SHTF and it's either you or nothing.  If you're hiking the Appalachian Trail and you come across a guy choking to death, if you think you can do it, go ahead and cric him - that's all on you.  When you're in an ED full of other professionals who are responsible (liable) for the care administered, know your role and stick to it.  I bet that horrible, nasty RN would be more likely to let you drop a line if he knew you could be counted on to stay within your role as a Tech when you weren't being actively supervised.


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## Shishkabob (Sep 23, 2010)

jtpaintball70 said:


> Linuss, most hospitals do not regard EMTs or medics as 'licensed' staff when their job title is not EMT or Paramedic. And a lot of time when you are working as a tech, your job title is the only thing that determines your scope of practice. The ED medical director is telling you what you are limited to, and could care less if you can do more somewhere else. Just the way a hospital works.



Exactly... it's been the BoN pushing for that type of mentality... atleast here in Texas.  It's getting to the point around here that while Paramedic techs can start IVs, they aren't even allowed to flush the line.  A nurse has to be the one to push the plunger.


Because obviously a Paramedic loses all their education the moment they enter the door to an ER and leave the rig....


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## dudemanguy (Sep 23, 2010)

They dont say nurses eat their young for nothing. Hospitals can be a pretty cut throat sink or swim environment, long term care facilities too. I work as a CNA and if a Nurse needs to tell a CNA something they should already know, its not a good thing, and if they need to do it more than once they will remember that.

I dont understand why the OP felt the urge to continually push the envelope of their scope of practice, just do what you are allowed to the best of your ability and leave the other stuff to people who are paid to do those things. I remember when I was doing my ER clinicals during EMT school, a patient once asked if I was a doctor in front of a nurse. The nurse, without looking up or even pausing just said 'no, hes.....nothing' lol. I think that kind of summed up the typical nurse opinion of EMTs, so it possibly annoyed this nurse to no end he caught you doing something he felt you arent qualified to do.


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## aewin90 (Sep 23, 2010)

dudemanguy said:


> They dont say nurses eat their young for nothing. Hospitals can be a pretty cut throat sink or swim environment, long term care facilities too. I work as a CNA and if a Nurse needs to tell a CNA something they should already know, its not a good thing, and if they need to do it more than once they will remember that.
> 
> I dont understand why the OP felt the urge to continually push the envelope of their scope of practice, just do what you are allowed to the best of your ability and leave the other stuff to people who are paid to do those things. I remember when I was doing my ER clinicals during EMT school, a patient once asked if I was a doctor in front of a nurse. The nurse, without looking up or even pausing just said 'no, hes.....nothing' lol. I think that kind of summed up the typical nurse opinion of EMTs, so it possibly annoyed this nurse to no end he caught you doing something he felt you arent qualified to do.



As a (thankfully former) CNA I can attest to this.  Pushing the envelope with nurses, especially when you're an "ambulance driver," is a bad idea.


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## TransportJockey (Sep 23, 2010)

dudemanguy said:


> They dont say nurses eat their young for nothing. Hospitals can be a pretty cut throat sink or swim environment, long term care facilities too. I work as a CNA and if a Nurse needs to tell a CNA something they should already know, its not a good thing, and if they need to do it more than once they will remember that.
> 
> I dont understand why the OP felt the urge to continually push the envelope of their scope of practice, just do what you are allowed to the best of your ability and leave the other stuff to people who are paid to do those things. I remember when I was doing my ER clinicals during EMT school, a patient once asked if I was a doctor in front of a nurse. The nurse, without looking up or even pausing just said 'no, hes.....nothing' lol. I think that kind of summed up the typical nurse opinion of EMTs, so it possibly annoyed this nurse to no end he caught you doing something he felt you arent qualified to do.



Actually that's a nurses opinion of most students. And that was my opinion of some nursing students when I was a floor tech


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## jjesusfreak01 (Sep 23, 2010)

dudemanguy said:


> The nurse, without looking up or even pausing just said 'no, hes.....nothing' lol.



Would have responded, "don't worry about her, she's just a nurse" then promptly walked to HR and tendered my resignation. Its not worth working with people who won't give you respect, regardless of your level.


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## medicRob (Sep 23, 2010)

jjesusfreak01 said:


> Would have responded, "don't worry about her, she's just a nurse" then promptly walked to HR and tendered my resignation. Its not worth working with people who won't give you respect, regardless of your level.



Yes, I believe that nurse definitely took it too far. I try to be respectful with everyone I work with and work together with them as a team. Calling a co-worker, a "Nothing" isn't in the best interest of the team and is just down right bad manners, especially in front of a patient. That nurse was out of line. You did not deserve that.


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## dudemanguy (Sep 25, 2010)

I'll add something more to this. I wasnt trying to bash or whine about nurses, so much as point out the hospital environment is different than EMS. EMS seems to have a little bit of commaraderie. You wont find that in hospitals(or LTC facilities). You will find a lot of bickering and back stabbing and gossiping. I've seen good CNAs get fired out of the blue in order to "make an example" of them, or because of personality clashes. 

The long term care facility I work at part time is even worse than the hospital, since there is not nearly enough time to get everything done exactly the way it is supposed to be, you are forced to cut some corners. Every so often Ive seen a CNA get crucified for doing what basically everyone else is doing. Usually its because they ran afoul of the wrong nurse, or even fellow CNA who has some pull.

The OP may have very well been perfectly good at their job, but maybe just gave the wrong person some rope to hang em with, and they used it.

It has really motivated me to get my paramedic patch and get the hell out of a hospital setting.


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## EMS49393 (Sep 25, 2010)

dudemanguy said:


> I'll add something more to this. I wasnt trying to bash or whine about nurses, so much as point out the hospital environment is different than EMS. EMS seems to have a little bit of commaraderie. You wont find that in hospitals(or LTC facilities). You will find a lot of bickering and back stabbing and gossiping. I've seen good CNAs get fired out of the blue in order to "make an example" of them, or because of personality clashes.
> 
> The long term care facility I work at part time is even worse than the hospital, since there is not nearly enough time to get everything done exactly the way it is supposed to be, you are forced to cut some corners. Every so often Ive seen a CNA get crucified for doing what basically everyone else is doing. Usually its because they ran afoul of the wrong nurse, or even fellow CNA who has some pull.
> 
> ...



Yeah, I don't know about that EMS comradeship thing.  The last few EMS jobs I've worked have been cut throat and back stabbing.  Some of the worst I've seen since working in the hospital.  I thought it was just me, but most of the old timers agree with me.  It's not what it was 15 or even 5 years ago.   You can't sling a dead cat in most areas without hitting and EMT or a paramedic.  When you have that many people all looking for jobs, they're going to start stepping all over people to get up the ladder.  

The days of "what happens on the truck, stays on the truck" are over.  What a shame, not being able to trust your partners anymore.


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## akflightmedic (Sep 26, 2010)

EMS49393 said:


> The days of "what happens on the truck, stays on the truck" are over.  What a shame, not being able to trust your partners anymore.



This is about the most asinine statement regarding EMS and you are not the only person to repeat it.

The only reason this type of mentality ever develops is a lack of professionalism. DO your job and do it well and you never have to worry about stuff :staying inside the truck". Act like a mature, professional adult.

Why do "WE" think we are any different from any other profession. Why do we "NEED" loyalty from a partner in a truck? Just do your job and follow the rules, quite simple.

I wonder if cooks fight and argue and say "Hey man, what happens in the kitchen stays in the kitchen"...or do teachers say "what happens in the classroom, stays in the classroom".

See how idiotic it sounds when you extrapolate it to every other profession? See how stupid "WE" are being by saying such dribble?


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## medicRob (Sep 26, 2010)

akflightmedic said:


> This is about the most asinine statement regarding EMS and you are not the only person to repeat it.
> 
> The only reason this type of mentality ever develops is a lack of professionalism. DO your job and do it well and you never have to worry about stuff :staying inside the truck". Act like a mature, professional adult



I couldn't agree more. It's also time to get rid of this, "Good Ole Boy" system of EMS where "Who you know" is valued more than "What you know".
I see it every day. Paramedics who could care less about learning something new or about evidence based medicine and all they do is sit
around and complain about, "Im sick of working this job". News flash, if you are sick of working EMS, get the hell out. 

As for this little, "What happens on the truck stays on the truck" mentality, that is down right ignorant. So are you saying if a Paramedic on your truck
pushed a wrong med and caused further harm to a patient, that you would just cover it up? That's what I'm hearing.

So how far exactly does this "What happens on the truck, stays on the truck" mentality go? Would you falsify a chart in this situation? After all,
that happened on the truck and we wouldn't want to get our partner in trouble. 

If you want to be accepted as a professional, act like one.


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## Emtpbill (Sep 26, 2010)

akflightmedic said:


> This is about the most asinine statement regarding EMS and you are not the only person to repeat it.
> 
> The only reason this type of mentality ever develops is a lack of professionalism. DO your job and do it well and you never have to worry about stuff :staying inside the truck". Act like a mature, professional adult.
> 
> ...



   I read your post to the new emts that were riding with me. While I agree 1000% with your statement the only thing that keeps coming to mind is the partner from hell. The one who operates on the edge. That treats their patients like it is a privledge that they get treated by him.
   And then the old feeling of " man, he did this and that wrong. Do I notify the superiors and be labeled a rat. Or handle it myself( keeping it in the truck).
    This moral dilema has faced people in all careers.  But when you are working a 12 or 24 hour shift with only one other person. Can make for a long tour.


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## Level1pedstech (Sep 26, 2010)

medicRob said:


> I have watched this thread and have held my tongue, but as a Registered Nurse, I feel it necessary to weigh in.
> 
> 
> It is YOUR responsibility to know your scope of practice. You were already in trouble, don't try to blame everyone else for your actions. We see it here all the time on this forum, people come in with, "I hate my Partner" or "My Job sucks" when it is usually the individual in question that is the issue, but instead of looking at their own actions and asking if they are perhaps the problem, they choose to blame someone else.
> ...



 Thank you for jumping in,we need all the RN's to get involved more often in some these discussions. Like you I see this behavior way to much in students moving thru the ER on clinicals and sometimes even in people who make it on to the floor as techs.


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## EMS49393 (Sep 26, 2010)

This constant bashing and bickering is a large reason why I want out of this profession.  All people do is beat each other up.  It's no wonder there isn't any trust anymore.

As for the truck statement, it has nothing to do with policies and rules.  I follow them quite fine.  My point is that I hear other people bash providers, bosses, etc., and judging from how they talk about them, I wonder what they say about me when I'm not around.  Almost all of what they say about other people I don't see myself and have a hard time believing.  It used to be different.  I didn't hear people talk so poorly about their partners.  I remember when we all got along well at work.  

You can't trust anyone in this job.  You probably can't trust anyone in any job.  If I can't trust a partner not to make up a bunch of tales about me or any other paramedic then I can't trust them to be there on a call when I need them.


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## Level1pedstech (Sep 26, 2010)

akflightmedic said:


> This is about the most asinine statement regarding EMS and you are not the only person to repeat it.
> 
> The only reason this type of mentality ever develops is a lack of professionalism. DO your job and do it well and you never have to worry about stuff :staying inside the truck". Act like a mature, professional adult.
> 
> ...




 I remember hearing "what happens on the engine stays on the engine" but it
was never in an attempt to cover up or hide unprofessional conduct. Usually chit chat on the engine was much like any other work place and of course included a bit of harmless gossip here and there. I don't think we will ever totally remove gossip from the work place I think its just human nature. I agree that we should never excuse poor conduct by keeping it on the engine or rig.


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## akflightmedic (Sep 26, 2010)

EMS49393 said:


> This constant bashing and bickering is a large reason why I want out of this profession.  All people do is beat each other up.  It's no wonder there isn't any trust anymore.
> 
> As for the truck statement, it has nothing to do with policies and rules.  I follow them quite fine.  My point is that I hear other people bash providers, bosses, etc., and judging from how they talk about them, I wonder what they say about me when I'm not around.  Almost all of what they say about other people I don't see myself and have a hard time believing.  It used to be different.  I didn't hear people talk so poorly about their partners.  I remember when we all got along well at work.
> 
> You can't trust anyone in this job.  You probably can't trust anyone in any job.  If I can't trust a partner not to make up a bunch of tales about me or any other paramedic then I can't trust them to be there on a call when I need them.



And when you "hear" these things, do you end the conversation or walk away from it? DO you make it known that you do NOT want to hear it?

This was a very difficult skill for me to learn and practice but what I have learned is people will eventually stop saying things about others in front of you and then when other people know that is how you are...they will do the same when they hear people talk about you or they will simply disregard anything they hear.

Sounds simple I know, but it isn't. The first thing that needs to change is yourself and very few of us ever admit we need to fix ourselves or expend the effort to change.


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## EMS49393 (Sep 26, 2010)

akflightmedic said:


> And when you "hear" these things, do you end the conversation or walk away from it? DO you make it known that you do NOT want to hear it?
> 
> This was a very difficult skill for me to learn and practice but what I have learned is people will eventually stop saying things about others in front of you and then when other people know that is how you are...they will do the same when they hear people talk about you or they will simply disregard anything they hear.
> 
> Sounds simple I know, but it isn't. The first thing that needs to change is yourself and very few of us ever admit we need to fix ourselves or expend the effort to change.



Actually I do which has done little but cause me more grief because I'm not a member of the bash everyone misery club.  One of my favorite things to say at work is "Really? I never seem to have that problem with them." I usually walk away from it after that. It seems as though this job is not maturing in any way and in fact I find it growing more juvenile with every shift.


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## Veneficus (Sep 26, 2010)

Has it occured to anyone not to take the "bashing" too personally?

Complaining about long term partners, like spouses, EMS partners, coworkers, etc. Is a coping mechanism. 

People who spend a lot of time together will do things that gets on each others' nerves. By complaining to a third party or even outloud, at work, etc, it allows the stress to be vented without causing a conflict between those people. 

The trouble i smost in this profession want to "help" people, so instead of just writing it off as venting and not giving it attention ever again it turns into "guess what who said about whom" and rhumors, and then retailiations, etc. 

As everyone here is well aware, we can give ten answers to one scenario and no two will agree. It doesn't mean any of us are idiots or suck. It simply means we have a different perspective. 

as always, the other person's perspective is never related or pobably even considered before judgement passed. 

In the past I have worked with people who one day told me: "I was really worried about the way you did things from what I heard, but there is a lot of logic in the way you do things when I see it."

Who among us has never heard "guess what person X did on a call?"  

Let the people vent. Then let it go. Don't take it as gospel, accurate, or even something that needs fixed.

I once attended a class about the psychology of women. Which was really about the difference in the psychology of men and women. 

It was described in Westenr society women look for consensus. Several examples were given. Men are raised in an almost paramilitary culture. From the games we all play to the perspective we all see, we are inundated and reinforced to this dispositions.

as an obvious disclaimer there are always outliers or crossovers, but knowing if somebody is "stupid, dangerous, or whatever" because they didn't follow the ascribed orders from the "usual" channels, or whether they want you to agree to support their decision as the right one will save you much grief in both the workplace and at home.


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## LonghornMedic (Sep 26, 2010)

EMS49393 said:


> The days of "what happens on the truck, stays on the truck" are over.  What a shame, not being able to trust your partners anymore.



The only time I tell anyone that is to students or new hires getting precepted. And it has nothing to do with treatment, treating patients rudely, etc. It mostly has to do with them hearing anything we may talk about and to not go babbling to others about it. When they are on a truck with us for anywhere from 12-24 hours, they are bound to hear us say things as we normally do as partners. They are expected to respect "what happens on the truck, stays on the truck" as a courtesy to being a guest on our truck.


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## EMS49393 (Sep 27, 2010)

Longhornmedic, thank you for clarifying my statement.  Its exactly what I meant but was unable to convey on only a few hours of sleep.


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## gary1969 (Sep 27, 2010)

*Supervision in the ER*

In all my years 35 almost I have never heard of anyone being fired for the reason as you describe it. I think apealing to HR or a Union if you have one is a good idea. Is their something else you are leaving out ?

As you go through life, remember "Fair" is a would that decribes an event with rides and ponies" Nothing in Life is absolutely fair. Many people have been fired for an unjust reason.. It's too bad but it happens every day.

Sometime a labor attorney will take your case. It's worth a try. I used to be a union president for a large government EMS system. Sometime we would take on cases just because they were so wrong and might set a president for our members.


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## akflightmedic (Sep 27, 2010)

Which president, Bush, Obama, Clinton?


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## Aussieaid (Sep 27, 2010)

8jimi8 said:


> So I came upon a scene with 2 paramedics who had just inserted an EJ.  I asked them if they knew what hydrocephalus was.  When they looked at me sideways I said,  "you are bolus'ing his brain.



Uh...I think someone needs to do a little A&P and pathophysiology review!


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## Aussieaid (Sep 27, 2010)

akflightmedic said:


> Which president, Bush, Obama, Clinton?



hehe!


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## Byrdman (Sep 28, 2010)

I'm going to leave my opinion even though this has been covered pretty good.

One question for me would be did the OP have gloves on? If he did, then I would assume he is preparing to stick. If not, then I might be inclined to think he isn't.

I ask this question because according to my National Registry skills test evaluation, the first step after preparing your equipment (which it seems the OP was supposed to have done) is to take proper BSI precautions.

My next part would be why is he doing something that is supposed to be done while under the title of "Nursing student"? I know in my area if you are working as an EMT while going to school for further licensing (EMT-B to EMT-I or EMT-I to Medic), if you are on the clock then you are to be operating AT your level. The only time you can perform skills above your certification level (outside of MD approval) is if you are specifically riding on the truck as a third member student.

The only time I can visualize a person finding a vein without the intent to stick would be if they are functioning under the role of a student and the RN says something like "see if you can find a vein but I'm going to stick"

As a student myself, the only time I would use my knowledge above and beyond my certification level is in assessment. If I were functioning as an ER tech, I would maybe use my knowledge to recognize that a patient is beginning to decline and alert the proper staff members. Similarly, if I were to witness a MVA or someone collapse I would operate as an "informed bystander" and be able to relay an accurate picture to the dispatcher instead of just saying "oh they look bad"

Bottom line, on the clock = do your job, nothing more, on clinical rotations = do what you're there to do. If you have even a little bit of doubt to if you are supposed to be doing it, don't do it. Sounds like the guy had doubt if he was supposed to be looking at veins.


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## Jeremy89 (Dec 23, 2010)

Byrdman said:


> ...One question for me would be did the OP have gloves on? If he did, then I would assume he is preparing to stick. If not, then I might be inclined to think he isn't.
> 
> I ask this question because according to my National Registry skills test evaluation, the first step after preparing your equipment (which it seems the OP was supposed to have done) is to take proper BSI precautions.



Nope- no gloves.  I feel with my bare hands first, then put gloves on once I find the spot- this was the common practice for most ED staff.



Byrdman said:


> My next part would be why is he doing something that is supposed to be done while under the title of "Nursing student"? I know in my area if you are working as an EMT while going to school for further licensing (EMT-B to EMT-I or EMT-I to Medic), if you are on the clock then you are to be operating AT your level. The only time you can perform skills above your certification level (outside of MD approval) is if you are specifically riding on the truck as a third member student.
> 
> The only time I can visualize a person finding a vein without the intent to stick would be if they are functioning under the role of a student and the RN says something like "see if you can find a vein but I'm going to stick"




As mentioned *we were trained for IV insertion* as long as the RN was okay with it.  I was looking for veins.  If he let me insert a line, great. If not, then no harm no foul.  Also, as previously mentioned, I could have drawn the blood without a nurse's delegation as soon as the doctor ordered it, but if someone is gonna get stuck for an IV, might as well get the blood then.  



Byrdman said:


> Bottom line, on the clock = do your job, nothing more, on clinical rotations = do what you're there to do. If you have even a little bit of doubt to if you are supposed to be doing it, don't do it. Sounds like the guy had doubt if he was supposed to be looking at veins.



I knew full well what I was doing- I was looking for veins.  If the nurse didn't come in within a couple more minutes, I would have drawn the blood from the patient and send the stat labs, something that is perfectly within my scope of practice an job description.  If he would have let me start a line, it also would have been fine, but all I was doing was looking- I didn't even have an alcohol prep pad or catheter opened.

I stand by my decision and would have done the same thing again.  Maybe I pushed the envelope a little bit- I'm one of those guys that wants to help whenever and however I can.  This is something that happened in the past and I have moved on.  Of all the reasons to be let go, I would much rather it be for "trying to help too much" then being lazy, doing nothing, being late, or, like another tech I worked with (who, by the way, got rehired)- taking and sending explicit pictures of himself at work.

By the way, the reason for termination was, according to Human Resources, NOT for practicing out of scope, but, rather, violation of policy/procedure (failure to get RN's permission before allegedly attempting to start an IV).


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## EMSLaw (Dec 23, 2010)

Linuss said:


> Meh, depends.
> 
> 
> Whilst there's "conspiracy" to commit a crime, there are also other crimes that don't actually happen until you commit it, regardless of intent.  (Shoplifting isn't shoplifting till you exit the store... you can hid all the merchandise in your clothing you want, but not illegal till you step past the last register, regardless if you walk around telling all the employees you're planning on stealing stuff.)



Hrm.  I'm thinking back to a case in law school that dealt with barbering without a license, and whether the offense was committed when the unlicensed barber picked up the tools, or when he actually began to cut hair...  

Either way, if one were to perform a "substantial step" towards the completion of the crime, that would constitute an attempt.  

I'm only halfway through this thread, but I feel like putting on the constricting band and palpating the vein is a bridge too far.  It's different from what the law might call "mere preparation" - spiking the bag, flushing the line, opening the tagaderm, tearing the tape, getting the saline flush ready and attaching it to the extension set...  whatever.


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## CodyHolt83 (Dec 23, 2010)

Well man, I hate to hear that you got fired.  Sounds to me, like you were simply just trying to help out.  Hopefully everything works out for you.


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