# Why I left pre-hospital medicine



## Mellowdnb (Sep 19, 2016)

I've worked in a variety of EMS settings. From urban high rise housing projects of Chicago, to the deserts of Arizona, the fields of OKC.

I've been in EMS for 8 years but I've always referred to myself as a lifelong student. I worked in a busy Chicago ED while attending Paramedic school. I am currently studying to be an RN. I love caring for patients & I love being around people. My 2 years in the ED as a tech was amazing & I loved the atmosphere.

Why did I leave EMS?

I was sick of the attitudes.

It's frustrating.

 It's frustrating to see how others who are supposed to provide compassion & care don't provide compassion to others.

 It's frustrating to see time & time again EMS staff abuse alcoholics & drug mis-users.

 I have seen firefighters & paramedics punch and kick patients.

 I am sick of seeing Paramedics administer narcan, at a rapid rate, to try to induce vomiting. They do it to "teach a lesson", as I was told.

I often wonder if the bad attitudes is due to the fact that many employees in EMS are alcoholics. This is a huge problem in this field.

 I was sick of seeing fellow co-workers treat patients like ****.

I was sick of hearing fellow co-workers complain about calls.

I was sick of hearing fellow co-workers give other employees **** for studying & trying to improve in this field.

I was sick of fellow co-workers talk **** about an employee's mistake yet they offered no help when an employee asked for help on how to prevent the mistake in the future.

I was sick of hearing fellow co-workers insist that methods used 15 years ago are still valid in this field.

I was sick of seeing Paramedics judge a patient & not give any pain meds. It happens more often than not.

My former medical director told my academy class to "Be nice" and threaten to fire us if we get too many complaints from patients. It's pathetic that the medical director of a large city has to resort to tell people to "Be nice".

Every field has problems. Show me a field without problems & I'll call you a dumb bullshitter.

Being an RN will have its frustrations. However, I enjoyed working 2 years in the ED.

As an RN, at least I can ensure my patient will receive a warm blanket & pillow without hearing "They don't need that".

I'll see just as much frustrations working as an RN but at least I can ensure my patient is treated with respect.


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## TransportJockey (Sep 19, 2016)

I'm sorry to hear that you've worked in such deplorable systems. I'm glad, myself, to have never worked in a system where it was that systemic and widespread. Where I am now, if we did most of what you said even once, there'd be no second chances and we'd be out on our asses. There are good places to work prehospital medicine. And I'm glad that I found one of them. Good luck to you in nursing school.


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## VentMonkey (Sep 19, 2016)

Ditto what TJ said. There are _excellent _services, and clinicians out there, but good luck, and hopefully you find some happiness, and are content with nursing, cheers.


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## NomadicMedic (Sep 19, 2016)

Wow. I'll just echo the above. there are some awful providers, but I've never seen anything that bad... Hope you find happiness.


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## johnrsemt (Sep 19, 2016)

I am glad as a RN you will always make sure that your patient will have a warm blanket and a pillow.   but when I was in medic school at an ED clinical  I was written up by a nurse for spending time finding a warm blanket for a patient who was cold.   Had nurses there that had no idea they had blanket warmers;  and never stocked them


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## RocketMedic (Sep 19, 2016)

You got a case of the EMSA, didn't you?


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## VentMonkey (Sep 19, 2016)

RocketMedic said:


> You got a case of the EMSA, didn't you?


I once had a case of "The AMR's". I moved, cures what ails ya


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## RocketMedic (Sep 19, 2016)

It's odd how certain places tend to cultivate that attitude. AMR, EMSA (AMR), Acadian....whereas places like Hall and Pafford, although not without their flaws, don't.


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## TransportJockey (Sep 19, 2016)

RocketMedic said:


> It's odd how certain places tend to cultivate that attitude. AMR, EMSA (AMR), Acadian....whereas places like Hall and Pafford, although not without their flaws, don't.


And even some AMR ops didn't cultivate that attitude. I think a lot boils down to regional or operation management.


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## VentMonkey (Sep 20, 2016)

TransportJockey said:


> And even some AMR ops didn't cultivate that attitude. I think a lot boils down to regional or operation management.


This is true. It seems to me most of their half way decent ops are, or were like that to begin with, and most of the management either remains, or does their best to see that it's kept the way it was before being absorbed.


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## DrParasite (Sep 20, 2016)

Mellowdnb said:


> Being an RN will have its frustrations. However, I enjoyed working 2 years in the ED.
> 
> As an RN, at least I can ensure my patient will receive a warm blanket & pillow without hearing "They don't need that".
> 
> I'll see just as much frustrations working as an RN but at least I can ensure my patient is treated with respect.


You want to hear something even sadder?   I have heard stories of hospital staff calling EMS management and filing complaints because the ambulance crew took too many blankets to stock their truck during the winter time.  And finding pillows in the ER was often unheard of.

I wish you the best of luck as an RN, the pay raise alone combined with the lack of need to work 60 hour weeks on a regular basis will go along way to maintaining your sanity.


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## Qulevrius (Sep 28, 2016)

Mellowdnb said:


> I was sick of seeing fellow co-workers treat patients like ****.
> 
> I was sick of hearing fellow co-workers complain about calls.
> 
> ...



I feel you. Used to work in a system like that, burnt me out & nearly made me allergic to anything pre-hospital. Am glad that I've spent the last few months with a good company, had great field management & a terrific partner; the difference was stark.


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## akflightmedic (Sep 28, 2016)

Qulevrius said:


> the difference was stark.



One can only imagine....

...


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## Mellowdnb (Sep 29, 2016)

The hospitals get charged for each blanket they use. Some store them in "vending machines", which weighs the blanket & sheet. 

 The hospital I worked at threatened to not give RNs their year end bonus if they kept using all the blankets. 

 The hospital paid a fee for the laundry service they used to decon the sheets.

 I found it amusing that the CEO and hospital big wigs can have 2 cars, 2 homes but they will ***** & moan about giving out blankets because it "Costs the hospital too much" X D


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## Summit (Sep 29, 2016)

I've never worked somewhere that I was pressured about linens.

I have been told that if your facility starts worrying about linens, it is a sign they are about to go under.


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## akflightmedic (Sep 29, 2016)

Mellowdnb said:


> I found it amusing that the CEO and hospital big wigs can have 2 cars, 2 homes but they will ***** & moan about giving out blankets because it "Costs the hospital too much" X D



You are confusing two issues....What the CEO saves the hospital may or may not be related to his compensation, but to lump in his two cars and two homes is poor logic.

Said CEO could simply make normal CEO salary and through this job or even past jobs and investments he is able to treat himself to two cars and two homes. It is not fair to say "why do you have two homes yet complain about linen use?" They are unrelated...

One may argue he gets more compensation by saving the hospital money and that may be true...but you cannot hold his personal homes and cars against his professional actions.


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## Carlos Danger (Sep 29, 2016)

Summit said:


> I've never worked somewhere that I was pressured about linens.
> 
> I have been told that if your facility starts worrying about linens, it is a sign they are about to go under.



I've never been "pressured" about linen use, but every place I've been they simply don't stock as much as we need. Apparently it is a really major cost.


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## Jim37F (Sep 29, 2016)

Most of our local hospitals participate in the "Linen Exchange" program (where since we have a bazillion hospitals right next to each other we can run multiple calls and not go to the same hospital twice so when we pick up linens from one hospital, put it on our gurney, then drop off the next patient at whatever hospital, they all use a third service to collect up the soiled EMS linens, launder them, then send them back to their original hospital so theoretically no one hospital actually loses linens....theoretically, and that's my somewhat limited understanding of the system).

Most of the hospitals are just fine you restocking what you used (take what you brought in, i.e. don't grab 5 flat sheets, 3 blankets and a handful of towels if you only used one flatsheet on the call....) Other hospitals have the designated EMS Linens cart and couldn't care less if you grabbed half the stock lol. Those are the real lifesavers because we have one or two hospitals in our area (one of them I go to regularly) that refuses to provide EMS linens so you have to use what you have onboard the ambulance to redress the gurney after each call.....if I go to that hospital 5 times in a row (also easily possible) I can run out of clean linens on the rig, so when we get to go to one of the "Don't care" hospitals I CAN restock by grabbing 5 flats sheets, 2 blankets, a handful of towels....


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## Jim37F (Sep 29, 2016)

Double post


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## Tigger (Sep 29, 2016)

Mellowdnb said:


> I'll see just as much frustrations working as an RN but at least I can ensure my patient is treated with respect.


I fail to see how this would be not be true of you as an EMS provider?

It isn't like patient abuse is somehow only endemic to EMS. I will be the first to admit that EMS has more than its fair share of flaws, but it isn't like we're the only part of healthcare that has this issue.


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## Qulevrius (Sep 29, 2016)

Tigger said:


> I fail to see how this would be not be true of you as an EMS provider?
> 
> It isn't like patient abuse is somehow only endemic to EMS. I will be the first to admit that EMS has more than its fair share of flaws, but it isn't like we're the only part of healthcare that has this issue.



I think what he meant is that there's significantly more red tape in definitive care rather than in pre-hospital setting, and I'm not talking about the set of dry rules. There are simply more people around.


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## Tigger (Sep 29, 2016)

Qulevrius said:


> I think what he meant is that there's significantly more red tape in definitive care rather than in pre-hospital setting, and I'm not talking about the set of dry rules. There are simply more people around.


I am not attempting to shift blame here. I get that EMS probably has a higher percentage of *******s than most of medicine considering how low the standards can be. But going to the hospital does not suddenly change this. All of the things the OP listed can and do happen in the hospital too.


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## Qulevrius (Sep 29, 2016)

Tigger said:


> I am not attempting to shift blame here. I get that EMS probably has a higher percentage of *******s than most of medicine considering how low the standards can be. But going to the hospital does not suddenly change this. All of the things the OP listed can and do happen in the hospital too.



You won't get any argument from me here. I'd even go as far as say that it isn't just the standards, but also some of the character types that EMS tends to attract. Indeed, going to the hospital won't suddenly change things for the better, all I'm saying is that the chances of shooting one's self in the foot are significantly higher, since there are more people around than just you, your partner and a(n) [abused] patient.


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## Francisco Fierro (Oct 7, 2016)

Mellowdnb said:


> I've worked in a variety of EMS settings. From urban high rise housing projects of Chicago, to the deserts of Arizona, the fields of OKC.
> 
> I've been in EMS for 8 years but I've always referred to myself as a lifelong student. I worked in a busy Chicago ED while attending Paramedic school. I am currently studying to be an RN. I love caring for patients & I love being around people. My 2 years in the ED as a tech was amazing & I loved the atmosphere.
> 
> ...




Wow i'm in shock to read your experience working in EMS. I'm currently studying to get certefied as an EMT and our instructor always reminds us that we are to give respect and compassion to all patients. Never judge or harm them, and has told us stories that have happened to him in the 32 years that he's been on the field. I just can't imagine working in an environment like you did, i would have left too tbh.


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## Carlos Danger (Oct 15, 2016)

OP, I hope you are happy in nursing. There are tons of opportunities within the nursing field, and generally speaking, it has some distinct advantages over working in EMS.

So this could be a great career move for you, or it could be one of those "the grass isn't always greener" situations. Going by the tone of your post here and a couple specific things you wrote in it, I really hope it isn't the latter.

I assure you that you will find _plenty_ of frustrations in nursing. You will probably deal with a heavy workload, and quite likely staffing and resource challenges. You will not have enough time to provide care the way you think your patients deserve. You will deal with stupid rules, cumbersome regulations, and ******* physicians, family members, managers, administrators, and co-workers. You will see patients discharged without getting the treatment or care that they really needed. You will have lots of very trying, taxing days.

Not trying to be a downer by any means - like I said already, here and many other times on this forum - nursing is a great career choice, and dovetails well with EMS. However, you need to go into it with your eyes wide open. It isn't a cakewalk by any means. The EMS meme about the pretty nurses sitting around all shift with their feet up joking and drinking latte's and flirting while they make bug $$ is just that - a meme.


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## Mellowdnb (Nov 3, 2016)

I worked as an ED Tech in a busy 30 bed Chicago ED. I've come just about as close as one can get to seeing what an RN endures without attending school. It's a real gut check. It's also full of the most wonderful, kind hearted spirits one can meet.

 It was busy. It was nothing compared to Mt. Sinai Hospital on the west side of Chicago. They get shootings, stabbings, rape victims on a regular basis. 

However, in order to be at your best, you have to have a lot of mental, physical & emotional endurance. 

The majority of patient population in an ED consists of the homeless. 

Many intoxicated patients frequent the ED. Many times they fight. They kick. They punch. They threaten to kill you. 

Prostitutes, both male & female frequent the ED. Many are rape victims. Many come in for STD treatments. 

Narcotic misusers often visit the ED. Many have lived a very, very, very sad life.

Many of them have grown up in a home with sexual abuse, physical abuse & psychological abuse. 

Elder abuse is also real. It sucks seeing it. 

Pediatric codes occur more often than you realize. 

I have bagged & tagged many patients; young & old.

 In a busy ED, everyone is busy. That includes the housekeeping staff. When one works in an ED, one is exposed to diseases, bacteria & viruses on a daily basis. It's very common to get an infection if careless work occurs. 

It's a real energy drainer. Energy spent needs POSITIVE energy put in.

The key to living a positive life is a clean diet, exercise & a good pair of shoes to prevent blisters! 

Nail care is a must. Open skin can be a common source of infection for scabies.  

Dry, cracked skin can lead to small cuts in the skin around nails.

Hand washing is a must. 

Hydration is key! Never underestimate the power of water to keep one awake. 

It's not easy being an RN. 

Much love to the RNs that provide a safe haven for patients in the burn units around the world.

Many of those patients are victims of abuse. 

Watching a wound cleaning is rough. I've done plenty in the ED but I have not cleaned a burn or MRSA wound. 

Nothing is more heart breaking than watching a pediatric patient endure a wound cleaning in the burn unit. 

The best part about being an RN is knowing you can show them love, peace, balance & kindness. 

Besides, having the funds to enjoy your day off is nice too.


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## Wild_Weasel (Nov 12, 2016)

Does somebody need a hug, should I call the wambulance?


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## RoadRat (Nov 13, 2016)

Francisco Fierro said:


> Wow i'm in shock to read your experience working in EMS. I'm currently studying to get certefied as an EMT and our instructor always reminds us that we are to give respect and compassion to all patients. Never judge or harm them, and has told us stories that have happened to him in the 32 years that he's been on the field. I just can't imagine working in an environment like you did, i would have left too tbh.



What happens in school and what actually occurs in a 911 field are worlds apart. Attitudes deteriorate rapidly because there is no longer the support of a regulated class schedule, classmates, and instructors. 

You're thrown from an environment of nurturing and into an environment of alienation, criticism, and insecurity. 

The only way you can maintain the idealistic attitudes of a generous provider with a warm and genuine bedside manner is if you are absolutely secure in yourself, paired with a skilled and willing partner, and are hired at a company with a fair and effective management system. 

It's possible, and there are many happy providers who touch their patient's hearts regularly. But it is a difficult mental art to master. Many try, and many fail. 



Sent from my iPhone using Tapatalk


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## Qulevrius (Nov 13, 2016)

RoadRat said:


> The only way you can maintain the idealistic attitudes of a generous provider with a warm and genuine bedside manner is if you are absolutely secure in yourself, paired with a skilled and willing partner, and are hired at a company with a fair and effective management system.
> 
> It's possible, and there are many happy providers who touch their patient's hearts regularly. But it is a difficult mental art to master. Many try, and many fail.



^ Pretty much this.

As it been already said countless times, people get into EMS for all kinds of wrong reasons. Then they get disillusioned and start blaming everything and everyone around. Anyone with a shred of critical thinking, either reevaluates and makes adjustments, or simply and quietly moves on, but there are some - and sadly, these are the majority - who 'bleat, weep and bleed but keep chewing on cacti'.


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## SandpitMedic (Nov 17, 2016)

akflightmedic said:


> You are confusing two issues....What the CEO saves the hospital may or may not be related to his compensation, but to lump in his two cars and two homes is poor logic.
> 
> Said CEO could simply make normal CEO salary and through this job or even past jobs and investments he is able to treat himself to two cars and two homes. It is not fair to say "why do you have two homes yet complain about linen use?" They are unrelated...
> 
> One may argue he gets more compensation by saving the hospital money and that may be true...but you cannot hold his personal homes and cars against his professional actions.


Refreshing.
I truly enjoy having the perspective of a person who started out like we all did and now runs multiple companies. 

Quite a lens to learn from if you're listening carefully.


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## SandpitMedic (Nov 17, 2016)

RoadRat said:


> What happens in school and what actually occurs in a 911 field are worlds apart. Attitudes deteriorate rapidly because there is no longer the support of a regulated class schedule, classmates, and instructors.
> 
> You're thrown from an environment of nurturing and into an environment of alienation, criticism, and insecurity.
> 
> ...


Mmmm. I'm feelin' this.
"All the gods, all the heavens, all the hells, are within you"


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## DrParasite (Nov 18, 2016)

Mellowdnb said:


> I've worked in a variety of EMS settings. From urban high rise housing projects of Chicago, to the deserts of Arizona, the fields of OKC.
> 
> I've been in EMS for 8 years but I've always referred to myself as a lifelong student. I worked in a busy Chicago ED while attending Paramedic school. I am currently studying to be an RN. I love caring for patients & I love being around people. My 2 years in the ED as a tech was amazing & I loved the atmosphere.


You know, you were in EMS for 8 years, in 3 different environments that are very very different.  In vastly different parts of the country.  Anyone ever tell you that you move around a lot, or are a nomadic provider?  I am guessing you are young, but moving so often would be a red flag as an employer that this potential employee was looking for a short term job, not a long term career


Mellowdnb said:


> It's frustrating to see how others who are supposed to provide compassion & care don't provide compassion to others.


its very frustrating to be a highly trained provider, and then learn that many of your patients could be handled by a taxi ride to their primary care physician.  Any even more frustrating to find that many people who call 911 for an emergency aren't experiencing a life of death emergency.  In EMT and paramedic school, you are taught to deal with emergencies, when in reality, the 911 system is over burned with non-emergency requests.


Mellowdnb said:


> It's frustrating to see time & time again EMS staff abuse alcoholics & drug mis-users.


it's frustrating to pick up the same substance abuser every saturday night.  


Mellowdnb said:


> I have seen firefighters & paramedics punch and kick patients.


I've had my partner assaulted by a patient, while the PD were there, and know firefighter and paramedics who where punched and kicked by patients, often with no criminal charges ever filed.


Mellowdnb said:


> I am sick of seeing Paramedics administer narcan, at a rapid rate, to try to induce vomiting. They do it to "teach a lesson", as I was told.


Well, if you keep saving them from the brink of death, day after day, week after week, why should they stop using opiods?


Mellowdnb said:


> I often wonder if the bad attitudes is due to the fact that many employees in EMS are alcoholics. This is a huge problem in this field.


After a long day, I enjoy an adult beverage or two.  as long as they aren't drunk while at work, what's the issue?


Mellowdnb said:


> I was sick of seeing fellow co-workers treat patients like ****.


I'm sick of management treating my coworkers like ***


Mellowdnb said:


> I was sick of hearing fellow co-workers complain about calls.


well, after your 18th calls in 11 hours, what would your reaction be?


Mellowdnb said:


> I was sick of hearing fellow co-workers give other employees **** for studying & trying to improve in this field.


your fancy book learning is great for school, but there is a huge difference between the classroom and the real world


Mellowdnb said:


> I was sick of fellow co-workers talk **** about an employee's mistake yet they offered no help when an employee asked for help on how to prevent the mistake in the future.


they should know their job, that's why they are there


Mellowdnb said:


> I was sick of hearing fellow co-workers insist that methods used 15 years ago are still valid in this field.


wait, you mean not ever sick person needs a NRB at 15 LPM and to be strapped to a backboard?  it worked great 15 years ago, have our mortality rates changed since then?  and besides, I do this job day in and day out, that's what experience is all about.


Mellowdnb said:


> I was sick of seeing Paramedics judge a patient & not give any pain meds. It happens more often than not.


I'm sick of patients calling 911 and requesting an ambulance, just so they can get narcotics form paramedics


Mellowdnb said:


> My former medical director told my academy class to "Be nice" and threaten to fire us if we get too many complaints from patients. It's pathetic that the medical director of a large city has to resort to tell people to "Be nice".


Really? not "treat the patient appropriately" or "use good clinical judgement", so I need to do what the patient wants, regardless of if it's warranted?  because if they demand morphine, and I refuse because it's not clinically indicated, and they complain, I'm in trouble?  You ever worked for an agency that ,regardless of the situation, if a complaint was filed, the employee was wrong until proven otherwise?  


Mellowdnb said:


> Every field has problems. Show me a field without problems & I'll call you a dumb bullshitter.
> 
> Being an RN will have its frustrations. However, I enjoyed working 2 years in the ED.


I'm sure you did, but you were a tech, not an RN.  Come talk to me when you have 5 patients, 2 are sick and need interventions, and you get a complaint because as a trauma was rolling in, you were assigned to help and your patient complained because you didn't answer the call bell fast enough.


Mellowdnb said:


> As an RN, at least I can ensure my patient will receive a warm blanket & pillow without hearing "They don't need that".


assuming you have an ample supply of warm blankets and pillows.  And your management doesn't threaten to fire or suspend you for using up all the blankets and pillows, so the rest of the shift or the new crew doesn't have any until the next delivery.


Mellowdnb said:


> I'll see just as much frustrations working as an RN but at least I can ensure my patient is treated with respect.


Come talk to me after working in a busy system and lets see how optimistic you are.

to the OP, many of your "frustrations" are valid, but what have YOU done to change them?  Did you notify your supervisor about these issues?  Did you ever confront the provider because what they were doing is wrong?

And some of your frustrations may be valid from your point of view, but have you tried to look at things from the provider that you are complaining about?  Not saying that what was wrong was correct, but maybe there were mitigating circumstances?

Your own history makes it seem like you never stayed in one place long enough to try to get anything changed.  You never became an FTO (to train new providers in how things should be), never became a supervisor (where you could make sure your personnel were doing the right thing), and never went into management (where you could make policy).  

Don't get me wrong, I think many of your "frustrations" are valid (and most of my responses above were simply to give you an opposing viewpoint), and being green and optimistic is great, but I also know that we won't work in a vacuum.  There are often outside factors that play more of an impact on your little ambulance.  This includes poor support from management, not enough resources to do the job well, lack of public health coverage and 911 system abuse, lack of legal protection for ems providers who get assaulted, the ongoing war on opiods, incorrect expectations of the career taught in class, and employees needing to work multiple jobs (often with back to back shifts) in order to provide for their families.  

I do wish you well in your nursing career, but I know a lot of nurses, especially inner city trauma nurses, as well as a couple nursing supervisors.  Dated a few too, and well as went drinking with a couple.  They frequently complained about their working conditions, working long hours with not enough staffing, not enough support from the doctors, inadequate or insufficient equipment to do the job, and ended up divorced miserable, and wishing they could go elsewhere, but they made too much $$$$ to be able to leave and maintain their life style.  

Sorry for the long post, but  I fear you might find some of the same frustrations throughout the healthcare system.


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## LaceyA (Nov 28, 2016)

RocketMedic said:


> You got a case of the EMSA, didn't you?



I was sadly thinking the same thing


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## RocketMedic (Nov 29, 2016)

LaceyA said:


> I was sadly thinking the same thing



It's a local culture and leadership issue.


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