# Nurses eat their young.



## Maya (Jan 31, 2010)

I'm in my second semester of medic school, just started clinicals.  I just got off my second shift in the ER.  Are all nurses really just total and absolute b*****s?  They're barely giving me any chance at all to get patient contact.  I'm a nice person, easy to get along with, although maybe a little shy because I feel like I'm getting in the way.

Five hours into my eight-hour shift--with not even one patient contact--and I was ready to go home and email the clinical coordinator to have my clinicals set up at another hospital.  One of the nurses asked me if I wanted to start a line on this patient and one of the other nurses said "no, he's not a good start.  He has really bad veins."  I asked the first nurse if I could just watch her start the line.  I walk into the room... the guy's 27 years old, healthy, with ropes for veins.  He says he's never had a problem getting a line started before.  Obviously, there was some reason the nurse was lying about him being a bad start.  I would have thought that I had given her the impression somehow that I was incompetent, except for the fact that I haven't even gotten the chance to do that--seriously, NO patient contact.

I have no idea what I've done to make the nurses have this attitude towards me and I have no idea how to change it!  If it keeps up this rate, I won't be able to get all of my patient contacts.  What can I do to change this?!  Any advice would be appreciated!


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## boingo (Jan 31, 2010)

Tough situation.  For some reason, perhaps someone will elaborate, or maybe its just my personal observation, female medic students get treated terrible in the ED by female nurses.  The opposite is the case in OB.  Your best bet is to shadow a doctor, resident or med student even, or make friends with the nursing staff.  Maybe I'm way out of line, but I see it all the time around here.  I'm sure one of the ladies here will set me straight, in the interim, good luck!


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## Maya (Jan 31, 2010)

Yeah, that was kind of my impression.  It was a really weird vibe that I was getting from the nurses.  I'm a nice person, I usually don't have any problems getting along with people.  I think, like you said, I'm going to have to find the one person who's a little more friendly and shadow them.  Otherwise, I'll have to schedule my clinicals at the local community hospital.

Thanks for the advice!


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## VentMedic (Jan 31, 2010)

Unfortunately some of these nurses also see the slackers that come through as both Paramedic and nursing students. They'll test you for awhile to see if you are a serious student or just in it for the patch as a Paramedic or for the money as a nurse. Nurses also are nurturing and protective of their patients, even the ones that some in EMS would throw out of their trucks as "BS" or find some reason to abuse them (see Appalled thread). Hang in there and show an interest in patient care. Eventually they'll let you participate if they see you are serious about providing patient care rather than occupying space just to get the hours in.


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## Dominion (Jan 31, 2010)

Mirror to what vent said and to add that I have had experiences with nurses in the past who were....less than friendly....around me.  Ones who despite me sticking hundreds of patients in my clinicals still are VERY reluctant to give me the supplies to do it myself.  I am fortunate to have had in my opinion one of the best clinical experiences I have heard of yet so I am a little biased in my ideals.  

With that said here is what I did when I first started.  First day I was VERY nervous.  I didn't do much.  My first stick my hands were shaking.  Second day I kinda had a feel for what to expect and I had a better day.  By my third day I felt confident enough, I already had access to the supply pixis so I told myself the only way I was going to get contacts was to jump in.  So everytime I saw a patient being brought in from triage, I walked with the triage nurse and asked what was going on and if they would need an IV/Blood draw.  I DID cross some people but for the most part the nurse would come in "Oh, you already got the line and bloods?   Awesome"  It took time but I worked with the same shift everytime and eventually it got to the point where I would be sought out to start lines, give meds, and perform other procedures.  In all of my clinicals I followed that attitude and jumped in head first on everything.  Got a cool sounding prodcedure?  Ask the doc if you can watch.  At the OR and there is a cool surgery happening?  Ask to go watch.  You'd be suprised at how much you will start to see and experience.  I never though I would get the chance to place a chest tube with the direction of a doc, but I did because I asked.  He kinda guided my hands but he took the time to show me how it was done.  

You need to be confident, it's ok to be nervous your first couple days, that's natural.  Be confident in your skills, even if you suck at IV's go stick the hardest patients.  Limit yourself to two sticks and go find someone else, eventually you'll get a HARD stick and you'll get it and you'll feel 100 ft tall.  The more you psych yourself out about it the more likely you will be to fail and get discouraged.  I approach every patient I am about to perform a procedure on as if I WILL get that procedure done. 

With all that said, it still doesn't make up for snotty nurses.  Some just don't want you to be there, plain and simple.  If you continue to have issues I recommend you speak with your program director or clinical coordinator to have those issues resolved.


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## 46Young (Jan 31, 2010)

Speaking of eating their young, most local (RN) assoc. programs are exceedingly difficult to handle while working FT. It still puzzles me why nursing programs have to be FT only. In speaking with local nurses, with both the NVCC program and the Germanna CC program (two local colleges), they basically tell you to quit your FT job, and that they "own you" for the next two years.

I find this strange, since there is still a high demand for nurses. I've also heard that the reason for the lack of availability in nursing programs is due to a lack of faculty, not so much as an overabundance of nursing hopefulls. I've been shopping around for the most job friendly program in my area, and came across this site:

http://www.virginia-nursing-schools.com/RN.htm

At the top of the page, it discusses the excellent job availability and industry growth for the field, and it also says the same thing about the lack of faculty for nursing programs near the bottom under the Virginia RN job outlook section. Perhaps this is a major factor in the unavailability of Pt participation, such as less than a full class load, or taking a semester off if needed, like degree programs in other non healthcare fields. I'm also at a loss as to why degree medic programs don't allow PT enrollment, either. When you're told that you need to give up your life for two years, and not work FT either, some will look for shortcuts (or not do it at all). Shortcuts such as five month medic mills and the Excelsior Medic-RN bridge.

At least NVCC's medic program holds the same class on two consecutive days, to accomidate personnel with rotating shifts. That's what I'm talking about, little things like that to help the working person.


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## 46Young (Jan 31, 2010)

During my ER clinicals, the RN's were more then happy to let me do their sticks and blood draws. Less work for them. I think that the key was that I was always asking "How can I help you", and "Is there anything else I can do to help right now". I would always step up to help pts to the restroom, always asking them how I can make them more comfortable, empty foleys, clean the cots for the next pt, do triage vitals, etc. I would usually initiate conversations with the pts as well, to help put them at ease, maybe pass a joke in good taste and such.


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## mycrofft (Jan 31, 2010)

*Ah here we go again. Yes, we eat our young.*

Remember that those folks who are not inhibiting you are invisible, the ones who stand out are the ones you are having trouble with.

As with tiger and shark attacks, you may be doing something that sets them off, but historically many nurses in my opinion and experience, and through anecdotes of many friends and classmates from nursing college, tend to make a decision about you, or the class they perceive you to belong to, and tend to want to drop the boom on "upstarts". If they don't, then they are "knowledgable but unassistive bystanders".

Nurses tend to be busy, and they are not being paid extra or even trained to be de facto instructors. Many (again, not a majority) also have a disdainful attitude towards EMT's and paramedics.

Suggestions as a former EMT, turned RN:
1. Go to your educational suprvisor/instructor/whoever put you there and complain. Keep a diary of who what and when, and don't  start throwing that info until you are forced to. That includes the contacts with your school on the matter. Once you start naming names you are only trying to protect your scholastic reputation, maybe trying to get your tuition back, because you may be _*through*_ at that training location.
2. Carry a flip pad in your pocket. Whenever you are called into a situation you anticipate to result insome sort of BS, go in with it already out, pen ready, and as you sit down write the date at the top of the page. Amazing how businesslike it gets, but it must be on your side of the table as wll as theirs.
3. Before all of that, come early one shift, seek out a sympathetic nurse or at least an honest one and ask to speak to them aside and privately. State that you feel you are not getting the chances you need, and ask if there is something you need to do or a way to act differently that will enlist these folks. Chances are this will get out in various versions to every gossip in the ED in a couple days, and things get better, or at least you may get some feedback.

I was screwed a couple times like that before I got the picture when a nurse took me aside, _after_ I'd been fired, and apologized about the politics. I took the abuse I was getting to be like that we used to hassle each other with goodnaturedly at the firehouse, but it was serious and wound up with me getting insufficient mentorship and being judged too slow to get with it. 

Be sharp, be confident without bragging or trying to get buddy buddy, know your stuff, bring food if it is customary, and just get it over with. You might even make some friends.


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## VentMedic (Jan 31, 2010)

46Young said:


> Speaking of eating their young, most local (RN) assoc. programs are exceedingly difficult to handle while working FT. It still puzzles me why nursing programs have to be FT only. In speaking with local nurses, with both the NVCC program and the Germanna CC program (two local colleges), they basically tell you to quit your FT job, and that they "own you" for the next two years.


 
Are you on that soapbox again?

Be glad it is only a 2 year program and it really should be a Bachelors.  Thank goodness you don't want to do another health care program that does require a Bachelors or a Masters.  

Also, as I have stated before, many of us who worked in the FDs and other full time jobs with families did advance our education because we knew of the rewards it would bring for a career.  If you don't have the ambition, don't go into nursing.  

Now at least Maya may have some idea of what the nurses who precept medic and nursing students go through with some entering these programs and those who do nothing but complain their entire time during clinicals.   There are those that will spend 7.5 hours complaining about how they shouldn't have to do this or they are too good for that and they have every excuse to accompany their shoulds and should nots.  These are the ones who are also always looking for a shortcuts when they don't feel like they are the "same as everyone else" and should be treated differently.


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## VentMedic (Jan 31, 2010)

mycrofft said:


> Nurses tend to be busy, and they are not being paid extra or even trained to be de facto instructors. Many (again, not a majority) also *have a disdainful attitude towards EMT's and paramedics.*


 
Have you noticed the nurse bashing threads on the EMS forums? 

The student, especially for Paramedic, must remember that the hospital is extending a learning privilege to the school which can be taken back. It is becoming harder to find hospitals that even allow clinicals for Paramedic students due to attitudes and screwups from improper training/education and screening  in the Paramedic programs.

Many of our hospitals no longer allow ETI in the ED by Paramedic students and IV starts were almost lost also due to the ignorance of a few students. They were racing each other starting IVs the "EMS way" with very little care for the site or for the patient. The L&D and Neonatal unit are also off limits and there is a very limited access to the Pedi ICU.


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## ExpatMedic0 (Jan 31, 2010)

I don't want to sound sexist but maybe try a male nurse to shadow if ones available, Its worth a shot? I was lucky most of my nurses where a blast to work with during my clinicals. 

On another note the younger doctors just out of school where always cooler to me


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## Ocean711 (Jan 31, 2010)

I think it might help to be proactive in your approach. I used to volunteer in a local ED and I had a hard time at first with the nurses and staff until I started asking if they needed any help. By the time I stopped volunteering, I knew the majority of the ED staff very well and was constantly busy because they knew I knew what I was doing. I noticed that they would give me more to do than some of the other volunteers who sat around and waited for the nurses to come over.


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## mycrofft (Jan 31, 2010)

*Vent I hear you about students coming in and acting badly.*

Fastest way out is to start complaining about your situation and trying to get an easy ride.

Institutions teaching paramedic need better incentives, then some sort of standards. I think it is something of an organizational CT scan when, due to BS like racing IV's, a training section is denied. They couldn't be bothered to find and eliminate or correct the problem cases so they deleted valuable experience for everyone...and probably meeting an organzational prejudice, revealing that their prioritization and value for training is not that high.

"Due to bad behavior, US History 101 is no longer being offered". What cr&p.

(We had a similar case where a surgeon acted badly with nursing students so we had our OR rotations cut to 1/2 length to avoid him. The other unit cut in half to take up the slack...ER).

I found most males in the teaching situation to be more collaborative, but not always. 

These are my observations. I'm sincerely sorry if they are too narrow, but "subjective is what I got".


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## Shishkabob (Jan 31, 2010)

I only ever had 1 problem with a nurse in all my clinical time, and she was promptly put in her place by the doctor I was with.  


If you aren't getting enough stuff to do, befriend the Charge nurse.  Ask if anything needs to be done, even if it's just changing the sheets or taking granny to the bathroom.  Always restock / fix the rooms as soon as it's clear so that it can be used for the next pt asap.  



On the same token, some nurses don't know that you're a medic student as opposed to a Basic student.  I had several nurses say they forgot I could give meds / start IV/ do NG/OG tubes/ other invasive things because they thought I was in EMT school.  Once they realized I was in medic school they let me do A LOT more.  

They all know you'll suck at IVs.  All of us did when starting.  I still suck at babies and grannies with no veins.  But once you start getting comfortable with your skills, they'll notice and be more lenient with you.  My 2nd day of clinicals, one of the nurses didn't believe I've only done IVs for one day as I was getting pretty good at them.  That boosted her confidence in me and let me do more.



Might be better if you befriend the techs, as most are either EMTs or medics themselves.  Once you get in good with them, they will get you on the nice side of the nurses.


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## kittaypie (Jan 31, 2010)

i agree with you about some nurses being like that. i've come across a few in my clinicals that haven't been the nicest. i've been very fortunate though to have mostly friendly and helpful staff at my clinical sites. try and find nurses and doctors that are genuinely interested in helping you learn, and stick with them!


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## 46Young (Feb 1, 2010)

VentMedic said:


> Are you on that soapbox again?
> 
> Be glad it is only a 2 year program and it really should be a Bachelors.  Thank goodness you don't want to do another health care program that does require a Bachelors or a Masters.
> 
> ...



Funny how after you get your Assosciates you can do the next two years at your own pace. Why not the first two? I don't see anything wrong with that.

Actually, I've found a way to make it work. I'll finish the EMS AAS, which will give me all the RN pre reqs save NAS 161/162. Everything except for the core classes will be taken care of, so I'll only be doing 9 credits or so per semester, except for the final one, which is unavoidably FT. After we buy a house, I'll bank some of my OT hours as comp time, to use for class time. I'll promote to EMS Tech next year, which is easy to do. I'll defer the LT promotion until I'm done with nursing, since I'll enjoy more seniority and copious OT than at the LT level. Speaking of which, the RN money will be a nice replacement for the lost OT opportunity. I'd like the job, and it's always good to have another income stream if I suffer permanent injury on the job. It would also be a nice part time job to have post retirement.

I still don't understand what purpose it serves to only have FT medic and RN schools, with no consideration for FT workers. Just because others have done it doesn't mean that the rules can't change.


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## VentMedic (Feb 1, 2010)

46Young said:


> I still don't understand what purpose it serves to only have FT medic and RN schools, with no consideration for FT workers. Just because others have done it doesn't mean that the rules can't change.


 
And why should everybody else be slowed down or inconvenienced because of a few "firemedics" that make excuses? With the budget cuts now that don't allow for a variety of programs with an unlimited number of educators, why force all the other nursing students who want to finish in two years to follow your slow pace? Others have actual goals and want to move on with their lives and make adjustments in their busy schedules for school.


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## 46Young (Feb 1, 2010)

VentMedic said:


> And why should everybody else be slowed down or inconvenienced because of a few "firemedics" that make excuses? With the budget cuts now that don't allow for a variety of programs with an unlimited number of educators, why force all the other nursing students who want to finish in two years to follow your slow pace? Others have actual goals and want to move on with their lives and make adjustments in their busy schedules for school.



Not a slow pace, but rather at your own pace. If you can finish at your own speed, that wouldn't be holding anyone else back. And how are you trying to make this a firemedic thing? The situation would apply to anyone with a FT job. In fact, what if someone needs their 9-5 job (office job or whatever) to support their family? How is that person supposed to free themselves up for three days/week or more for two years? Those in the fire service at least have a fighting chance with a rotating schedule for ten days a month, and shift swaps available. There do exist some night programs, but not in my area. If there was, I would just switch to day work and be fine. 

My example of NVCC holding extra classes for medic students on rotating shifts was just an example of accomidating working professionals. For nursing, allowing flexible clinical days would help. For example, instead of reporting to the hospital on M/W/F, maybe the student could go on M/T/TH that particular week. NVCC's program allows for online didactic, but some of that is synchronous. That takes the benefit of distance learning away, as you still need to be available during the time the synchronous lecture is being held. Realize that when you do shift swaps, those trades need to be repaid. If you don't return the favors, then you'll be stuck in your final semesters with no way to attend class, thereby wasting your time invested, as you can't complete the program. 

I don't find flexible classes (or at the very least off site clinicals) or synchronous online classes to be unreasonable. Especially with the demand for nurses still significant. Besides, how many of these older nurses got their start with a simple diploma? Sure, they went back and earned their two and four year degrees (and more), but it was at their own pace, part time if they wanted. Newcomers need to have degrees. The job demands it. The older nurses earned their degrees with a part time option, why not the current students? That's why I see no fault in getting my medic card through a tech school and getting the degree afterward. Just because some have done it FT while working FT doesn't mean that everyone else should be made to do the same, at least not without some accomidations to help with time management. The work in completing the degree gets done regardless, but while allowing other obligations such as providing for a family, and being there physically for them as well, among other things. 

How many people wish they could go back to school but can't since they need their FT job to survive, and can't make both schedules jive for whatever legitimate reason?

Synchronous online didactic, flexible clinicals, and/or allowed part time enrollment would make school much more manageable for FT workers. The work still gets done. Family and financial obligations are still satisfied. 

When you went to school FT as a FF/medic, did how much irreplaceable time did you lose with your children? They only grow up once. Or was this before children?


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## JPINFV (Feb 1, 2010)

Want to attend: Part time medical school.


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## firetender (Feb 1, 2010)

*Something to Consider*

You're new. People smell it. They can pick up your insecurities as well as a dog knows when you're afraid. It's part of the territory when you're new. The way it usually lessens its grip on you is when you take your focus off of what everybody else MIGHT be thinking -- about your knowledge and experience or lack thereof -- and just keep focused on the task at hand.

There are aspects of your newness that you don't have control over: like how insecure practitioners will take advantage of caca flowing downhill; and there are things about your newness that you DO have control over: like how much energy you give THE a-holes who like to torture the Newbies!

Though I do see the technical value in  Mycrofft's defensive posture, I call in to question the amount of your personal energy that it would take to maintain that kind of vigilance. I'd rather see you keep your eye on the ball, getting to be the best you can and moving around the roadblocks rather than resisting or being stopped by them. Use the others' suggestions about seeking mentors that give you what you need. They are out there.


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## rescuepoppy (Feb 1, 2010)

I have found that one of the reasons for the way some nurses treat students is that they become protective of the patients in their care. They have in too many cases had students either nursing or medic students come into their unit with the attitude of "that is not the way this is done,we do it this way". You have to remember these are the people who have been doing this for a lot longer than the student has. 

    Recently I was doing clinical time in or local hospital,I had the fortune to do all of my time with a nurse who had not too long ago came there from another hospital she did not know any of the students or their background so did not know that I had been a paramedic before but had to let my certification lapse due to various reasons and was taking the entire course again to update my skills and education level. She was at first very reluctant to allow me or any other student perform any type of procedure,but most of us found that as long as we approached her with the attitude of teach me rather than I know everything we were allowed to take on a role of more and more responsibility. As long as we go into things with th right attitude we will find that most nurses do not hate students what they have a problem with is that they have seen too many students come in with too high of an opinion of themselves.


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## VentMedic (Feb 1, 2010)

46Young said:


> When you went to school FT as a FF/medic, did how much irreplaceable time did you lose with your children? They only grow up once. Or was this before children?


 
Do you understand the word "choice"?   What is this selfish need you have for all nursing students to take 6 years to finish a 2 year program just so you can go?

It is very simple...if you can't cut it or have other priorities, don't go back to school.  The FD doesn't care if you are a nurse.  

Do you understand there is not enough money and resources to design professional programs around every individual?  Why should a FF be made the exception?  Maybe not everyone wants to stretch out their program to 6 years.  But, isn't that the EMS way for some? Take a 110 hour course and stretch it out to a year by going 1 night a week just to say you attended a "year long" EMT program. 

People have found ways to get an education long before you and will continue to do some.  Most are mature enough not to make an excuse for every little thing.  They have their goals in mind and do it.  You obviously don't want this bad enough or you would have already had a degree. You are well into your 30s and are still whining like you are in elementary school looking for a reason to play hooky.    Do you honestly think your attitude would be welcome in any college level program which has serious students who have made adjustments in their lives to get an education?   



> Besides, how many of these older nurses got their start with a simple diploma?


 
Do your realize that diploma was over 2 years in length and required the students to live in a dorm in some programs?  Do you realize those living in the dorms were also subject to being on call as extra hands at any time of the night?   There are still several of these older nurses around from these programs that believe the 2 year degrees are too easy on the students.  

There is no way EMS in the U.S. will ever require anything more than a few hours of training due to some of the attitudes it attracts.   Many of the FFs who do have a good career don't want to put forth the extra effort which is also why they have gotten the bad reputation when it comes to providing EMS.  Some want too many shortcuts and exceptions made for the poor FF who already has another job and EMS really is just something extra to get the funding.   Isn't that how you are viewing the RN?  It is just something a little extra for some additional money?   It's not really a career for you but more of a hobby so you don't have any time to spend on it.  Thus, you selfishly want other nursing students, who will make the RN a career, to do the program in a way that takes care of you and the hell with the rest.   

You can't see why some older nurses would not want to precept someone like you who is constantly whining, making excuses and looking for shortcuts?


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## Level1pedstech (Feb 1, 2010)

Maya, let me give you an ER techs view of your situation. There are several ways to improve your ER time but lets try the easy ones first.

 Having seen many students of all levels pass through our ED over the years I can tell you that your success lies in your ability to exercise your critical thinking skills and be two steps ahead of the game from the time you start your shift. If you spend your time waiting for someone to take your hand and show you the way you have already missed the boat. You should have been oriented to the department and should know your boundaries. Don't rely on the staff to make your clinical time a success. Most RN's really enjoy the role of teacher but that role is second to their role as RN. Even the nicest nurses and techs have bad days and like vent mentioned some have grown weary from the waves of less than stellar students that flow through the system. 

 The other easy solution is to try another crew and see if you gel better with a different group. We have two crews that split the night schedule and they are worlds apart in style and substance. Example, my favorite crew to shift with likes wings,pizza and other treats that are not so healthy but fun to enjoy the other crew is humus,fruit and veggies all the way, fine if your a small furry little animal but not the greatest in my opinion for late night ER snacking. One crew is really into having fun the other is more rigid and by the book. Both get the job done but the experience is compleatly different, I think you get the point.

 It is so important that you make good use of your time and learn all you can while in the ER. I honestly think that clinicals can make or break most students. Books are fine but one on one contact with really sick folks is the only true way for a student to judge if health care is their calling. I have seen plenty of people who had no business anywhere near sick people and a few who just needed to break out of their shells. Please feel free to PM me if you have any questions I would be happy to help you make the best of your ER time.


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## Level1pedstech (Feb 1, 2010)

VentMedic said:


> Have you noticed the nurse bashing threads on the EMS forums?
> 
> The student, especially for Paramedic, must remember that the hospital is extending a learning privilege to the school which can be taken back. It is becoming harder to find hospitals that even allow clinicals for Paramedic students due to attitudes and screwups from improper training/education and screening  in the Paramedic programs.
> 
> Many of our hospitals no longer allow ETI in the ED by Paramedic students and IV starts were almost lost also due to the ignorance of a few students. They were racing each other starting IVs the "EMS way" with very little care for the site or for the patient. The L&D and Neonatal unit are also off limits and there is a very limited access to the Pedi ICU.




 Great points and well worth mentioning. I can tell you from my own observations that the students are the ones that cause the problem and in the future may find it hard to even get ER time let alone clinical time in other specialties. We still allow medic students in the OR,L+D,ICU and PICU but it might not be long until we restrict our units. I think its like many other problems that stem from the practice of allowing anyone with a pulse and a bank account into some of these programs. There are always going to be people that ruin a good thing for everyone else and its hard to filter out the problem children before its to late. This will not be the last time we touch on this subject.


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## Veneficus (Feb 1, 2010)

JPINFV said:


> Want to attend: Part time medical school.



Why on earth would you want that?

It is long enough as it is.


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## JPINFV (Feb 1, 2010)

...but then I can work a cool ambulance gig on the side that means I won't have to take out student loans!


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## TransportJockey (Feb 1, 2010)

I never had a problem during my clinicals, part of it was because I knew a lot of the staff that was in the EDs. Either from dropping off or picking up in their ED or they were staff that worked PRN there and full time at my facility where I'm a tech.

There was one day where the nurses were a little less than helpful and that was because the other medic student at the clinical site with me that day decided to mouth off to a very senior charge nurse and got himself thrown out.


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## Veneficus (Feb 1, 2010)

Figured I should address the OP.

First off, nurses are human. (I know there is a lot of propaganda about being a nurse) Some humans like to teach, some do not. Some are better than others. If you don’t think you are not getting a proper education, switch to another preceptor, or even another clinical site. Ask the natives who the best preceptors are. You’d be surprised how easy that info is to come by.
Birds of a feather flock together. As pointed out, not just in the ED, people whose personalities mesh tend to work the same shift. If your personality or values clash with the shift you are doing clinicals with you will have a negative experience. 

Be proactive. Often students who hang around waiting to be told are viewed as slackers, not shy or unsure. Once you are seen as a slacker, it is a tough label to break. Personally I hate students who bring books to study. If you are reading a book at a clinical site, you are unprepared and not doing what you are supposed to, which is to get hands on experience. If you really have nothing to do, ask questions. Even if you know the answer. Showing you are engaged pays dividends. 

Remember who you work for. Spend some time with the doctor. The responsibilities of a nurse and other healthcare providers are different, as are their priorities. Just like working with firemen or police officers in the field, you sometimes have to give a little to get something.

Nurses are not all bad. I have many friends who are nurses, as well as being the student of some outstanding preceptors who were nurses. Just like anyone, there are bad apples. You have to steer clear of them. 

Don’t forget some nurses know it all.  In my experience some of them seem to bash everyone for their lack of knowledge. Paramedics, doctors, radiology techs, respiratory therapists, and even other nurses; sometimes it seems nobody knows as much as they do.(especially evident in 4 year programs) I especially like to read the professional nursing journals that have doctor bashing articles. Just like spoiled children, being told how great/important you are all the time has a profound effect. 

Even among staff from other fields, some EMS schools have a stigma about them. If the staff are used to a lack of quality from your program, right or wrong, it always manifests. Then you need to go the extra mile just to get out of the hole.  

Most important, help out!  Sure you are there to learn/practice certain skills, but in any ED I have been a part of, there is always more to do than people to do it. Ask if you can help do some of the less glamorous tasks. I don’t know anyone who would turn down help changing soiled linens.

Be an asset. Just like in EMS, vitals need to be updated every so often. Just do it. Then give it to the nurse for her to chart. Get the patient a cup of water. (make sure it is ok for them to have it first) Try to help patients be more comfortable. It makes life easier for the nurse. If one presses a call light, respond and see if you can help. I have found great success in simply explaining to patients how long regular events take. (like lab work) I also like to remind them in the hospital no news is good news. When providers are flocking to your bedside, a patient should probably be worried. This takes pressure off of the nurse. Additionally if a patient needs to be pushed across the hall, a bed made, etc. Ask if you can do it. 

Most nurses I know are assigned a “pod” or an area of some kind. They probably have to stock it. Ask them if you can help. If equipment needs tested ask them to show you how.

Find out about the patients your preceptor is assigned to, don’t just walk around looking for skills practice.

Also don’t forget to give your preceptor some space. It also helps to tell people what you are permitted to do and what you need to get done. (IVs assessments, etc.)  

Most important. There is no such thing as "field medicine." The principles of medical science are always the same. Sometimes the techniques may vary, when in Rome do as the Romans do. Nobody cares how "it really works in the field," or how "paramedics do it."


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## Veneficus (Feb 1, 2010)

JPINFV said:


> ...but then I can work a cool ambulance gig on the side that means I won't have to take out student loans!



Let me know what ambulance company pays enough to cover the costs of medical school, I will apply straight away.


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## mississippimedic (Feb 1, 2010)

The best advice that I could give is to stay busy. If you are at a slower hospital don't just sit around and play with your black berry or similar device.  If you have nothing else to do bring your text book and study.  Interact with the staff ask them any questions you may have.  We didn't really have any problems with clinicals, we knew what was expected of us.  If we made problems for the hospital staff depending on the severity, we had one chance.  The second time a student made trouble he would likely be dropped from the program.  I wouldn't worry about the nurse you spoke of, she may have had a bad day or like anywhere you go, you will always find at least one Ahole. Just keep a positive attitude.


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## VentMedic (Feb 1, 2010)

Veneficus said:


> Don’t forget some nurses know it all.  In my experience some of them seem to bash everyone for their lack of knowledge. Paramedics, doctors, radiology techs, respiratory therapists, and even other nurses; sometimes it seems nobody knows as much as they do.(especially evident in 4 year programs) I especially like to read the professional nursing journals that have doctor bashing articles. Just like spoiled children, being told how great/important you are all the time has a profound effect.


 
Nurses are also feeling the pinch of being one of the least educated licensed professionals in the hospital setting. One could also include the administrative staff who generally have Masters. The BSN is becoming the way to go in nursing to make oneself marketable. Even the Respiratory Therapists are now petitioning for the Bills that will recognize their status with Bachelors and Masters. They, RRTs and RNs, realize they are way behind the other Allied Health professions in education with just a mere Associates degree. Nurses also see their status slipping everyday in the Multidisciplinary meetings. Thus, the BSN is not one of arrogance but rather one of survival now in an ever changing world of medicine.

Then, you get a few in a Paramedic program that brag about being "doctor like" with just a few hundred hours of training to do a few cool skills while the RNs are going back for the BSNs and MSNs just stay competitive, it can become a little tense. Of course the Paramedic also symbolizes a time when LVNs were allowed in acute hospital settings where they could do a lot with very little education. The same when Respiratory and Radiology Techs were just certificates from 1 year schools. Those times where only skills were adequate for a job are gone as the knowledge must now be there. Unfortunately some Paramedics still only focus on "skills" and do not respect the "knowledge" that other professionals have or they believe the nurse has nothing to offer them because the Paramedic "is close to being a doctor". They also get so wrapped up in the "skill" that they forget to see there is so much more to patient care. The RN must not only be concerned about "skills" but also plan total patient care be it for discharge or admission to the floor.


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## VentMedic (Feb 1, 2010)

mississippimedic said:


> If you have nothing else to do bring your text book and study.


 
I agree with Veneficus about this. If we see you bring a book to clinicals, the first thought is you are behind and plan to use the time as a study hall period and probably don't want to be bothered with what the ED staff has to offer.  

Also, if you can not find something to do in an ED no matter how slow it is, then that just demonstrates how little you do know and should seek out more information from the staff in that ED.  Even reading the volumes of protocol and procedure manuals that nurses have can be enlightening.  Few Paramedics understand how nurses function or what happens to their patients after they arrive at the ED.  Even looking over the various assessment paperwork that RNs much complete can give the Paramedic student a look into how many detailed assessments are involved in patient care for the long haul.  Each diagnosis and procedure can generate a new care plan for assessment with a different focus.


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## Veneficus (Feb 1, 2010)

VentMedic said:


> Nurses are also feeling the pinch of being one of the least educated licensed professionals in the hospital setting. One could also include the administrative staff who generally have Masters. The BSN is becoming the way to go in nursing to make oneself marketable. Even the Respiratory Therapists are now petitioning for the Bills that will recognize their status with Bachelors and Masters. They, RRTs and RNs, realize they are way behind the other Allied Health professions in education with just a mere Associates degree. Nurses also see their status slipping everyday in the Multidisciplinary meetings. Thus, the BSN is not one of arrogance but rather one of survival now in an ever changing world of medicine.



Unfortunately I see it manifest as arrogance all the time. Could it be that the reason nursing is being marginalized is because the profession has tried to move beyond the required role? Medicine has many researchers with advanced degrees. Who needs one more? Especially one with a BS? Is nursing really a science or a BA marketed as a science and its lack of basic science evident? What about the nurse being a "manager" or unlicenced staff? Many hands on providers look down on paper pushers. There is also the question of nursing's drive to make everything routine. Perhaps routine leads to complacency? 

I am not a nurse. I don't know the reasoning, only what I see. These are questions I have no answers to, only a perspective to consider.  



VentMedic said:


> Then, you get a few in a Paramedic program that brag about being "doctor like" with just a few hundred hours of training to do a few cool skills while the RNs are going back for the BSNs and MSNs just stay competitive, it can become a little tense. Of course the Paramedic also symbolizes a time when LVNs were allowed in acute hospital settings where they could do a lot with very little education. The same when Respiratory and Radiology Techs were just certificates from 1 year schools. Those times where only skills were adequate for a job are gone as the knowledge must now be there. Unfortunately some Paramedics still only focus on "skills" and do not respect the "knowledge" that other professionals have or they believe the nurse has nothing to offer them because the Paramedic "is close to being a doctor". They also get so wrapped up in the "skill" that they forget to see there is so much more to patient care.



I think nobody in the right mind would dispute this.



VentMedic said:


> The RN must not only be concerned about "skills" but also plan total patient care be it for discharge or admission to the floor.



An advanced practicioner such as a NP or CRNA may have these responsibilities, certainly not the average RN. In the hospitals I am affiliated with both home and abroad, it is still the doctor than plans patient care and arranges for admission or discharges. Nursing carries out these directives.

Sure they have their nurse to nurse reports and other administrative procedures, but they are certainly not the primary decision makers. Just like many paramedics, to me, many in nursing seem to want decision making capability without responsibility. One without the other is simply impossible. I strongly suspect that same idea of authority without responsibility plays a significant role in their being marginalized in multidiscipline gatherings.


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## VentMedic (Feb 1, 2010)

Veneficus said:


> Unfortunately I see it manifest as arrogance all the time. Could it be that the reason nursing is being marginalized is because the profession has tried to move beyond the required role? Medicine has many researchers with advanced degrees. *Who needs one more?* Especially one with a BS? Is nursing really a science or a BA marketed as a science and its lack of basic science evident? What about the nurse being a "manager" or unlicenced staff? Many hands on providers look down on paper pushers. There is also the question of nursing's drive to make everything routine. Perhaps routine leads to complacency?


 
You think a 4 year degree is too much for an RN? Gee! What an insult! You must also have a seriously low opinion of OTs, PTs and SLPs as well.

And you believe nurses have no role in research? Are you even aware of the research that they have been doing for decades? You must really be shocked to know there are RRTs with Ph.Ds who also do research. I've even heard they exist in ALL the other licensed health care professions. How shocking! 

There is a difference between routine and have a standard plan of care as a guide to ensure as little as possible is missed in the performance of patient care. 



Veneficus said:


> An advanced practicioner such as a NP or CRNA may have these responsibilities, certainly not the average RN. In the hospitals I am affiliated with both home and abroad, it is still the doctor than plans patient care and arranges for admission or discharges. Nursing carries out these directives.


 
What "skills" are you thinking about? There are more "skills" than intubation and IVs. 

Are you even aware of care plans that RNs make out or those that are done as multidisciplinary plans for review with a team which does include a doctor. A doctor does NOT have to time to prepare one of these which are now required for each and every patient. 

Also have you ever heard of Case Managers who are nurses? The doctor says "discharge" and it is up to them to figure out how, when and where. Very few doctors get involved in the actual details of discharge except for writing the scripts for meds.



Veneficus said:


> Sure they have their nurse to nurse reports and other administrative procedures, but they are certainly not the primary decision makers. Just like many paramedics, to me, many in nursing seem to want decision making capability without responsibility. One without the other is simply impossible. I strongly suspect that same idea of authority without responsibility plays a significant role in their being marginalized in multidiscipline gatherings.


 
You are not a nurse. You obviously do not work with nurses and you really don't know what they do. Do you even know what the role of multidisciplinary meetings are and how they differ in the various patient care areas? Ever hear of a little agency called JCAHO? Do you know what their tracers consist of? Ever hear of nurse driven protocols? Do you honestly think one physician can micomanage all the care that is involved with just one patient? 

You seem to think that some low level health care worker like a nurse should know their place and be happy with just the required entry level education. You seem to think if they get more education they are arrogant and believe they are better than doctors. There seems to me like you have some misbeliefs about education and the world of medicine. Like it or not other health care professionals are seeing the importance of education as medicine and technology advances. Nurses no longer wear short white dresses and want to sit on doctors' lap to give them a good time at work in hope of marrying one. Times have changed. 

It is disgusting that there are such attitudes towards educated health care professionals in the year 2010.

I figured this would turn into another nurse bash thread.


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## Veneficus (Feb 1, 2010)

VentMedic said:


> You think a 4 year degree is too much for an RN? Gee! What an insult! You must also have a seriously low opinion of OTs, PTs and SLPs as well.



I am not sure how you came to that conclusion. I think you over reacted to the point I was trying to make, which is that it is possible to have too many people managing and not enough providers actually performing care.In smaller words, the chief to indian ratio. Of course you wil now probably level an accusation of my bias against native cultures. Having a host of aids and techs to perform nursing duties is economcally unsound. It also devalues a nurse to the role of "middle manager." If you look at expendable persons in any industry, middle management is not the place to be.



VentMedic said:


> And you believe nurses have no role in research? Are you even aware of the research that they have been doing for decades?



I have been living in a hole all my life, I have no idea of the world around me.

I believe that researchers should have advanced degrees. At least a master's. Many nurses I know agree that too much emphasis in the 4 year degree is placed on research and not enough of patient care, am I evil incarnate for having the same opinion because I am not a nurse?




VentMedic said:


> You must really be shocked to know there are RRTs with Ph.Ds who also do research. I've even heard they exist in ALL the other licensed health care professions. How shocking!



People with Ph.Ds do research? Amazing!
I am not sure why you felt this would add anything. 



VentMedic said:


> There is a difference between routine and have a standard plan of care as a guide to ensure as little as possible is missed in the performance of patient care.



Sounds to me like a cookbook. I thought cookbook medicine was bad medicine. Oh well, I guess I am going to hell.



VentMedic said:


> What "skills" are you thinking about? There are more "skills" than intubation and IVs.



I have reread my post, I cannot find where I mentioned skills. I did mention that advanced nursing providers have considerable resposibilities compared to an RN. Perhaps I am mistaken?



VentMedic said:


> Are you even aware of care plans that RNs make out or those that are done as multidisciplinary plans for review with a team which does include a doctor. A doctor does NOT have to time to prepare one of these which are now required for each and every patient.



I have been party to many multidisciplinary meetings. In my observations in such, I have noticed that more weight is given to any party that provides direct care over parties that simply administrate, regardless of title or degree. I have also noticed that the doctor does tend to listen to and sign the plan.   



VentMedic said:


> Also have you ever heard of Case Managers who are nurses? *The doctor says "discharge"* and it is up to them to figure out how, when and where.  Very few doctors get involved in the actual details of discharge.


 
My point was it is not the nurse that makes the decision to discharge, but carries out the directive. Not only was that what I said, you quoted it verbatim. You then question whether or not I have heard of a nurse that carries out the details of the doctor's directive? 



VentMedic said:


> You are not a nurse. You obviously do not work with nurses and you really don't know what they do.



I wonder how you can possibly make such a statement. I am not a nurse. (I think I said that.) In all of my hospital and educational experience is it possible I do/have not worked with a nurse? How could I possibly know the responsibilities of my coworkers and friends? While passionate, I don't think you put much thought into this statement. It seems you were merely hell bent on leveling a personal attack.



VentMedic said:


> Do you even know what the role of multidisciplinary meetings are and how they differ in the various patient care areas? Ever hear of a little agency called JCAHO? Do you know what their tracers consist of? Ever hear of *nurse driven protocols*? Do you honestly think one physician can micomanage all the care that is involved with just one patient?



Ignoring the fluff, isn't a protocol a standing order? A set of guidlines of which care is based? I wonder who signed off on these "protocols?" I don't recall suggesting that physicians micromanage care, but for some strange reason physicians do like to be involved in care and decision making. Perhaps you are suggesting that a physician is superfluous in the care of patients?



VentMedic said:


> You seem to think that some low level health care worker like a nurse should know their place and be happy with just the required entry level education.



I don't think you understood what it is I said. Is there a language you would be more comfortable with I could have translated? Again, I stated that if people no longer perform a valuable function, they would eliminate their own position. What a person or professions wants to do and what is needed do not always coincide. 




VentMedic said:


> You seem to think if they get more education they are arrogant and believe they are better than doctors.



I stated that I have witnessed nurses who exhibted that type of behavior. I also stated that I have seen nursing publications that had articles printed about the inappropriate treatment of patients by doctors. I do perceive that to be arrogant, just as I would perceive a paramedic who believed they knew more about healthcare than a nurse to be arrogant. 



VentMedic said:


> There seems to me like you have some misbeliefs about education and the world of medicine. Like it or not other health care professionals are seeing the importance of education as medicine and technology advances.



I don't think that "medicine" and "healthcare" are synonymous. I would be more convinced they were if the educational coursework were more similar. (more basic science and less "fundamentals of nursing") I have yet to take a class in "fundamentals of medicine" or "fundamentals of physicians." 

I also don't think my academic pondering of roles and value in healthcare is an attack on education or a profession. Furthermore, I think that being critical of EMS education, roles, and value without being critical of other professions is a bit biased. Certainly not conducive to improvement in healthcare quality, patient care, meaningful debate, or research. 



VentMedic said:


> Nurses no longer wear short white dresses and want to sit on doctors' lap to give them a good time at work in hope of marrying one. Times have changed.



Very colorful. Other than attempting to deter healthy debate, what is this statement supposed to accomplish?




VentMedic said:


> It is disgusting that there are such attitudes towards educated health care professionals in the year 2010.



Is it as disgusting as creating a strawman argument and leveling personal attacks about knowledge, experience, and observations in order to suppress academic discourse?



VentMedic said:


> I figured this would turn into another nurse bash thread.



I offered my observations, put forth topics of debate based on such. Is that really bashing?

Would it be fair to say if we cannot debate other healthcare professions roles and values that we are limiting this forum to EMS bashing?


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## VentMedic (Feb 1, 2010)

Veneficus said:


> I am not sure how you came to that conclusion. I think you over reacted to the point I was trying to make, which is that it is possible to have too many people managing and not enough providers actually performing care.In smaller words, the chief to indian ratio. Of course you wil now probably level an accusation of my bias against native cultures. Having a host of* aids and techs to perform nursing duties is economcally unsound.* It also devalues a nurse to the role of "middle manager." If you look at expendable persons in any industry, middle management is not the place to be.


 
Now you are calling OTs, PTs and SLPs "techs"?  You really have a very low opinion of health care professionals. 



Veneficus said:


> I have been living in a hole all my life, I have no idea of the world around me.


 
Obviously.



Veneficus said:


> I believe that researchers should have advanced degrees. At least a master's. Many nurses I know agree that too much emphasis in the 4 year degree is placed on research and not enough of patient care, am I evil incarnate for having the same opinion because I am not a nurse?


 
Do you know that in most major cities there are more BSN programs than ADN?  Do you know it has been that way for about 3 decades now?  If you do not know what a nurse does, how are you the one to just that they don't do any patient care if they have a BSN?   



Veneficus said:


> People with Ph.Ds do research? Amazing!
> I am not sure why you felt this would add anything.


 
Because you seem to not believe anybody except a medical doctor can have "education" and definitely don't need another profession doing research with all the doctors around.  You just stated that in your previous post.



Veneficus said:


> Sounds to me like a cookbook. I thought cookbook medicine was bad medicine. Oh well, I guess I am going to hell.


 
Protocols and guidelines. Even doctors have them.  You implied the nurses are useless unless an order is written for every procedure they do.  News flash for you; no doctor would have time for that.  



Veneficus said:


> I have reread my post, I cannot find where I mentioned skills. I did mention that advanced nursing providers have considerable resposibilities compared to an RN. Perhaps I am mistaken?


 
I mentioned the skills and you replied only the advanced practitioners.  Try listing every skill that an RN does or even the LVN.  You might be amazed.  I have Paramedics do this when they believe they do a lot of skills for an eye opening experience. 



Veneficus said:


> I have been party to many multidisciplinary meetings. In my observations in such, I have noticed that more weight is given to any party that provides direct care over parties that simply administrate, regardless of title or degree. I have also noticed that the doctor does tend to listen to and sign the plan.


 
I do not mean a bedside report which a doctor signs that he/she saw the patient but a multidisciplinary meeting that satisfies the JCAHO requirements.  There is a difference and every unit or patient care area has their own meetings and plans.  



Veneficus said:


> My point was it is not the nurse that makes the decision to discharge, but carries out the directive. Not only was that what I said, you quoted it verbatim. You then question whether or not I have heard of a nurse that carries out the details of the doctor's directive?


  Do you know what all is involved in the discharge of a patient. Yes the doctor writes the word "discharge" but do you really know what happens after that? 



Veneficus said:


> I wonder how you can possibly make such a statement. I am not a nurse. (I think I said that.) In all of my hospital and educational experience is it possible I do/have not worked with a nurse? How could I possibly know the responsibilities of my coworkers and friends? While passionate, I don't think you put much thought into this statement. It seems you were merely hell bent on leveling a personal attack.


 
The statements you have made against nurses do not speak of experience.  In fact, you seem hell bent on "putting nurses" in their place by bashing those that dare to get a BSN.    I can't imagine what you must think of a Paramedic that dares to get a two year degree.  



Veneficus said:


> Ignoring the fluff, isn't a protocol a standing order? A set of guidlines of which care is based? I wonder who signed off on these "protocols?" I don't recall suggesting that physicians micromanage care, but for some strange reason physicians do like to be involved in care and decision making. Perhaps you are suggesting that a physician is superfluous in the care of patients?


 
Yes the nurse work under protocols that are signed off by physicians and they also work under those that do not require a doctor's signature to provide total patient care.   Do you think a doctor wants to get involved in what equipment to order, wound care surveilance or any of the hundreds of things that go into total patient care?    Do you think the physician should write for how many times to dump the foley because by your reasoning, the nurse is too stupid for that and must have a doctor signed order.




Veneficus said:


> I don't think you understood what it is I said. Is there a language you would be more comfortable with I could have translated? Again, I stated that *if people no longer perform a valuable function, they would eliminate their own position.* What a person or professions wants to do and what is needed do not always coincide.


 
Do you honestly think education will lead to the extinction of a profession?  PTs have a doctorate and they are now in serious demand.  Do you believe the nurses should just go back to being known as "bed pan dumpers" rather than professionals in health care?  What about all the other professions that have now achieved worth and recognition by insuring agencies because of their education?  Do you even realize how much medicine is advancing and the technology that is used today that requires people to have advanced education?  

I guess you also support the EMT staying at 110 hours of training and the Paramedic  to stay at 700 hours.  




Veneficus said:


> I stated that I have witnessed nurses who exhibted that type of behavior. I also stated that I have seen nursing publications that had articles printed about the inappropriate treatment of patients by doctors. I do perceive that to be arrogant, just as I would perceive a paramedic who believed they knew more about healthcare than a nurse to be arrogant.


 
Yes and we just has a doctor arrested for child porn again.   We've also had doctors arrested for molesting their patients.   Sometimes a nurse or any other professional has to be a patient advocate.   If a doctor writes an order that can harm a patient, it is the nurse's responsibility to point it out whether the doctor likes it or not.  If a nurse makes a med error he/she must also answer for it.   



Veneficus said:


> I don't think that "medicine" and "healthcare" are synonymous. I would be more convinced they were if the educational coursework were more similar. (more basic science and less "fundamentals of nursing") I have yet to take a class in "fundamentals of medicine" or "fundamentals of physicians."


 
Do you think nurses are only educated out of one "Fundamentals of Nursing" book?    They do have a text book entitled Critical Care Medicine.  How about Pediatric Primary Care?  One of my many textbooks were titled "Respiratory Medicine".  However, I do not claim to be a medical doctor because of the title but I also believe RT and the RN are very much a part of medicine.



Veneficus said:


> I also don't think my academic pondering of roles and value in healthcare is an attack on education or a profession. Furthermore, I think that being critical of EMS education, roles, and value without being critical of other professions is a bit biased. Certainly not conducive to improvement in healthcare quality, patient care, meaningful debate, or research.
> 
> Very colorful. Other than attempting to deter healthy debate, what is this statement supposed to accomplish?


 
You have made belittling statement about nursing and other health care professions.  You have essentially stated that the RN should not become educated which puts them back into short skirts sitting on the doctor's lap like in the soaps.  You believe they should remain uneducated fools that only know how to say "yes doctor" and have no say in patient care. 



Veneficus said:


> Is it as disgusting as creating a strawman argument and leveling personal attacks about knowledge, experience, and observations in order to suppress academic discourse?


 
You made it personal by attacking educated health care professionals which I happen to be in that category.   Your belief that only the medical doctor should have higher education and all the others should be known as techs and not professions is outdated for modern medicine. 



Veneficus said:


> I offered my observations, put forth topics of debate based on such. Is that really bashing?
> 
> Would it be fair to say if we cannot debate other healthcare professions roles and values that we are limiting this forum to EMS bashing?


 
If you can not accept a BSN for nurses, I can not see you ever advocating for education in EMS.  Afterall, EMTs and Paramedics must follow protocols just like nurses.    Even a 2 year degree for the Paramedic must seem absurd to you.  And yes, I've got one of those as well in EMS.


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## firetender (Feb 1, 2010)

*Dear VentMedic*

I respect your contribution to the site, your experience, much of what you stand for, and I appreciate the time you take to share your knowledge and experience with those coming up in the ranks.

AND...

If I hadn't been seeing a pattern I'd keep my mouth shut. But just a couple minutes ago, I found myself stepping away from learning anything constructive from you because, quite frankly I wasn't willing to keep running in to two arrogant invectives for every kernel of wisdom you offered.

...and I could be a little off base here, taking into consideration how typing is no substitute for face-to-face meeting, but what happens to me when I run in to a clearly disdainful comment toward a poster or one of a poster's thoughts or positions, I become prejudiced and skeptical of whatever follows. Now that turns in to a lot of work for me to learn something from you, doesn't it?

I get and appreciate the whole Kali, Warrioress; protector of the brood aspect of you and your work, and, at the same time, recoil from some of your approaches which are all about resistance and underneath it all, what comes through is anger. 

I really don't care if your anger is all about the ideas you have around protecting your patients or profession(s). This Forum is just WORDS! Anger is anger and I don't want to be around it. AND I don't want to miss what you say!

I'm not perfect myself; you've pointed that out and I've accepted it and looked at it and even did use the reflection you prompted in me to make changes in attitude. Now, I'm asking you to hear me, and ask that you accept the offer as a sign of friendship, for all of our benefit.


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## Maya (Feb 1, 2010)

Thank you for all of the advice!  I can already see a few things that I am going to try to do differently.  When I wrote the OP, I had just gotten off of that last shift and was so frustrated, especially since that nurse had so obviously lied to me about the patient who she said was a bad stick.  It just felt like such a slap in the face.

I guess, from my perspective, I have only 200 clinical hours to perfect my skills before I am out in the field doing my internship.  I will sign up for more hours if I feel that I still need improvement once clinicals are over, but it's really frustrating to stand around for eight hours doing nothing besides changing sheets.  All of the medics I've talked to have said that I should be getting 20-30 IV's started in one shift and I'm getting maybe 2 or 3.  I can get the minimum number of patient contacts that I need to pass my clinicals, which is 40 IV starts and 10 live intubations--but what kind of medic will I be if I've only performed the minimum number of skills?

The way I see it, this is a really small community.  It's only a matter of time before I'm in the back of an ambulance with one of the ER staff's friends or family members.  I won't have a team of doctors and nurses to help me.  I'll have an EMT and maybe a couple firefighters if I'm lucky.  If I'm running a Code and I'm 15-30 minutes from the hospital, can't get an IV started to push meds and can't get the patient intubated, it sucks for me as a medic, but it REALLY sucks for the patient.  They could die.  I really don't want to be fumbling around, practicing my skills in the field during a code.  I would like to be doing it in the hospital, in a controlled setting, the way I'm supposed to be.

Taking a step back, I can understand why the nurses would be protective of their patients.  It's really unfortunate that they would have a bad impression of medic students just from past experiences.  I've already requested to do the rest of my clinicals at another hospital.  I didn't tell the clinical coordinator why, because I really didn't want to make a big deal about it.  I still have 2 more weeks at this hospital though, so I'm going to do my best to relax, be nice, be ridiculously helpful, and will come armed with large quantities of sugary baked goods to appease the nurses.  I don't want to give the medic class a bad reputation at this hospital and spoil it for everyone else.

Thank you for all the insight, you guys!  I'll work on writing my patient assessments in my downtime, have fun, and just see what I can help with around the ED, whatever that may be!


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## VentMedic (Feb 1, 2010)

My dearest firetender,

I am not the type that will sit back and allow someone to state that the many health care professions are not part of medicine. Nor will I remain quiet while someone states that those in the many health care professions remain as "techs" since education will make them arrogant even at a 4 year degree level. To want those in health care to not obtain higher educational goals because "they only take orders from the doctor" is just absurd. I will continue to emphasize that the world of medicine is constantly evolving and that one should not just do the bare minimum if they are serious about a career in any of the health care fields. 

I seriously do not want some to believe that nurses or any health care professional are stupid or arrogant because of their career choice and no health care provider should be criticized for advancing their education or belittle by those who think "they should know their place" and not try to know more then the bare minimum to do a skill or a task. 

I have argued these points for 30 years in EMS and I also have had the opportunity to see how education brings professional growth to the many professsions in the hospital. I will not sit back quietly and allow someone attempt to say higher education in health care is not necessary and a privilege reserved only the medical doctors. 

I would like the many health care professions to understand each other. Those in the hospitals have had to come to agreements because of the many regulations that demanded a working team effort be created for the good of the patient. Education was also a large part of leveling the playing field for the many different health care professions. The advanced education and research efforts have led to many innovations in improving patient outcomes. I just can not sit quietly when one can not see how education at the frontlines of patient care can not be of benefit for anything other than to promote arrogance. I also do not want those just starting out and trying to find a path for themselves to believe education is the root of all evil in health care....that is unless you are a doctor.

I will also continue to push those in EMS to get more education because a few hours of training is not enough for the responsibility they have been trusted with.  For those who believe those few hours entitle them to more respect than any other profession because of a few impressive skills, I do encourage them especially to go back to college.


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## VentMedic (Feb 1, 2010)

Maya said:


> It's really unfortunate that they would have a bad impression of medic students just from past experiences.


 
It is a little more than just a few experiences from students. Our ED sees well over 100 ambulance crews (both private and FD) each day. The ED staff gets to see both the good and the bad from all of these crews. There are some days where we would love to detour all crews to another hospital or just lock the ED doors allowing only the patients in because of the bad apples on that particular shift. There are other shifts where the EMT(P)s get invited to our gatherings both in and outside of work.


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## Maya (Feb 1, 2010)

Level1pedstech said:


> I would be happy to help you make the best of your ER time.



--Thank you, Level1pedstech,  I really appreciate the good advice!


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## Veneficus (Feb 1, 2010)

VentMedic said:


> Now you are calling OTs, PTs and SLPs "techs"?  You really have a very low opinion of health care professionals.



Perhaps I should have said nursing aides and er techs? You are the one who listed those providers as aides and techs, not me.



VentMedic said:


> Do you know that in most major cities there are more BSN programs than ADN?  Do you know it has been that way for about 3 decades now?  If you do not know what a nurse does, how are you the one to just that they don't do any patient care if they have a BSN?.



Is it possible for me to know anything? By the measure here, I am lucky I figured out how to tie my shoes. (I confess, I just slip them on and off)

I also never stated that a BSN doesn't do patient care, I stated that I think there is not enough focus on patient care compared to other aspects. I formulated that opinion from speaking with nurses who have a BSN or better. Clearly even they don't know enough about nursing to help me form an intelligent opinion.    



VentMedic said:


> Be*cause you seem to not believe anybody except a medical doctor* can have "education" and definitely don't need another profession doing research with all the doctors around.  You just stated that in your previous post.



I never once said medical doctor, I am of the opinion there are enough people with advanced degrees (in many areas) that do research that taking up people with a BSN to do research may not be the best use of resources. Perhaps there is a nursing shortage? 

I think you only read what you want to. I also noticed that you don't so much debate as fanatically defend the "true" faith of which only you seem to be privy to the workings of. Such a position does not do you justice.



VentMedic said:


> Protocols and guidelines. Even doctors have them.  You implied the nurses are useless unless an order is written for every procedure they do.  News flash for you; no doctor would have time for that..



I made no such implication, I am sorry my thoughts may be too advanced for you to comprehend without twisting them to argue what seems to be the only position you can argue effectively.  



VentMedic said:


> I mentioned the skills and you replied only the advanced practitioners.  Try listing every skill that an RN does or even the LVN.  You might be amazed.  I have Paramedics do this when they believe they do a lot of skills for an eye opening experience.



You mentioned the skills, I made statement regarding advanced practicioners and you equated them together. You did so erroneously.



VentMedic said:


> I do not mean a bedside report which a doctor signs that he/she saw the patient but a multidisciplinary meeting that satisfies the JCAHO requirements.  There is a difference and every unit or patient care area has their own meetings and plans.



I have sat at such meetings in 3 countries. Perhaps I may have some insight? However since you seem to be creating your own arguments and attributing them to me, I doubt anything I could offer would be of much use to you. 



VentMedic said:


> Do you know what all is involved in the discharge of a patient. Yes the doctor writes the word "discharge" but do you really know what happens after that?


 
Even if I did would you acknowledge it? Irregardless, who cares? It has nothing to do with my position or statement.



VentMedic said:


> The statements you have made against nurses do not speak of experience.  In fact, you seem hell bent on "putting nurses" in their place by bashing those that dare to get a BSN.    I can't imagine what you must think of a Paramedic that dares to get a two year degree.


 
I do quite often muse on the distribution of healthcare resources. I don't have the time to put anyone in their place, and even if I did, once again you have made up an argument by erroneously attributing to me an idea I did not put forth. 



VentMedic said:


> Yes the nurse work under protocols that are signed off by physicians and they also work under those that do not require a doctor's signature to provide total patient care.   Do you think a doctor wants to get involved in what equipment to order, wound care surveilance or any of the hundreds of things that go into total patient care?    Do you think the physician should write for how many times to dump the foley because by your reasoning, the nurse is too stupid for that and must have a doctor signed order..



What can I say? I did not say or imply micromanagement existed or needed to, once again you made something up to support what I can only describe as a delusion. 



VentMedic said:


> Do you honestly think education will lead to the extinction of a profession?  PTs have a doctorate and they are now in serious demand.  Do you believe the nurses should just go back to being known as "bed pan dumpers" rather than professionals in health care?  What about all the other professions that have now achieved worth and recognition by insuring agencies because of their education?  Do you even realize how much medicine is advancing and the technology that is used today that requires people to have advanced education?



It seems that I couldn't possibly know anything about medicine in your mind. (niether could anyone else for that matter) Your other questions have nothing to do with my statements. Save them for somebody who cares to hear it.



VentMedic said:


> I guess you also support the EMT staying at 110 hours of training and the Paramedic  to stay at 700 hours.


 
I will let my many previous statements about EMS education speak to that. 




VentMedic said:


> Yes and we just has a doctor arrested for child porn again.   We've also had doctors arrested for molesting their patients.   Sometimes a nurse or any other professional has to be a patient advocate.   If a doctor writes an order that can harm a patient, it is the nurse's responsibility to point it out whether the doctor likes it or not.  If a nurse makes a med error he/she must also answer for it.



I will indulge this idiotic statement for just to point out that criminal behavior is not exclusive to physicians.    



VentMedic said:


> Do you think nurses are only educated out of one "Fundamentals of Nursing" book?    They do have a text book entitled Critical Care Medicine.  How about Pediatric Primary Care?  One of my many textbooks were titled "Respiratory Medicine".  However, I do not claim to be a medical doctor because of the title but I also believe RT and the RN are very much a part of medicine.



Why would you belittle your knowledge by calling yourself a medical doctor? Clearly RRT or Nursing have made such a provider obsolete in your mind. I guess education can kill a profession. 



VentMedic said:


> You have made belittling statement about nursing and other health care professions.  You have essentially stated that the RN should not become educated which puts them back into short skirts sitting on the doctor's lap like in the soaps.  You believe they should remain uneducated fools that only know how to say "yes doctor" and have no say in patient care.


 
Actually I think you have posted more belittling statements than I have and made yourself feel better by attributing them to me. I stated that nursing has been distancing itself from its core foundation and delegating responsibility to providers such as nursing aids, assistants, techs, and other unlicenced providers. Somehow in your mind that expanded to PT, OT, etc.

You apparently had to then fabricate implied meaning behind my statements in order to satisfy some need of defending "the true faith" of healthcare providers and even toss your "oh the downtrodden female relegated to a sex object wearing a skirt" nonsense into the mix.

You seem to have some very deep seated issues that you have not been able to resolve that keep recurring. You may want to seek the aid of a professional for help with resolution as it is beyond the scope of an internet forum. 




VentMedic said:


> You made it personal by attacking educated health care professionals which I happen to be in that category.   Your belief that only the medical doctor should have higher education and all the others should be known as techs and not professions is outdated for modern medicine.



I did nothing of the sort, you superimposed your delusion on what it was I said. (another recurring theme in your posts) I have tried to clarify my thoughts believing it to be a misunderstanding. But I was mistaken. It seems very much like a psych issue. 




VentMedic said:


> If you can not accept a BSN for nurses, I can not see you ever advocating for education in EMS.  Afterall, EMTs and Paramedics must follow protocols just like nurses.    Even a 2 year degree for the Paramedic must seem absurd to you.  And yes, I've got one of those as well in EMS.



I never suggested nurses should not have a BSN, only that we should debate the economic value of having nurses removed from their core professional contributions. I also stated that I think a higher degree than a BS should be required for research.


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## Sasha (Feb 1, 2010)

> Last edited by Veneficus; Today at 10:37 PM. Reason: accepted a bribe



Don't you feel better now? You don't seem so grouchy in your post.


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## Veneficus (Feb 1, 2010)

Sasha said:


> Don't you feel better now? You don't seem so grouchy in your post.



I was being very sincere


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## Sasha (Feb 1, 2010)

Veneficus said:


> I was being very sincere



You were being very mean. It is unattractive.


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## ffemt8978 (Feb 1, 2010)

And that's enough of this one.


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