# RN REFUSES to give REPORT.



## RanchoEMT (Jan 1, 2011)

Well as the Title may give away, I was working BLS/IFT the other day picking up out of a Kaiser, in San Bernardino County.  Our Patient was originally admitted for CVA a few days prior and was being transported across county lines to a nursing facility approximately 40 miles away.  Upon contact with the sending Nurse and after asking for a report, the Nurse states that she has never given a report in her entire time working at this facility and does not feel it necessary to tell the crew(Myself/Partner) now.  NOR, does she give our crew any type of face sheet for billing. We are given a paper with her diagnosis (Only) and her prescribed Medications.
-A summarized Version-
 I ask her: "How long have u worked here?"  
Nurse: “What does that have to do with anything?!”
Myself: “You’ve never given a report or a Face Sheet to any ambulance Crew You’ve ever handed a Pt. too. How Long Have U done this?”
Nurse:  “That is not relevant.”
Myself: “ What if my patient goes south on the way to where were going and I have to give a report to an ER Not knowing what her Med HX, Allergies, DOB, Last Blood Sugar, etc. is?!?!  What if she has MRSA, or something else and b/c of YOU IM NOW INFECTED?!?! “
Nurse: “We do NOT give out this information here!!!!”
Myself: “ What’s your Name?”

YADA YADA YADA

My partner plays the reasonable middleman and tries to explain why we need what we do.  Flustered and red, I call my supervisor and he states this is typical of Kaiser, and that we are to document and transport.  Nurse then takes blood sugar after arguing for several minutes, previously stating that she CAN’T take it again for another 2 hours.”

Myself: “ WHY can’t u take a blood sugar now?!”
Nurse: “b/c  I can’t.”
Myself: “ WHY?”
Nurse: “B/C I CANT.”
Myself: “ WHY?”
Nurse: “B/C I CANT!” (Crazy  Eyes Engaged)
Myself: “ CANT? Or Wont!”


To Summarize RN refuses to give:
Face Sheet(D.O.B., SSN, Insurance, demographics, etc.)
Med Hx
(Contact Pre-Cautions info)
Allergies
Blood Sugar(@ time of Transport)
DNR
Other Pertinent info (will be transported with Foley, hasn’t eaten, Spanish Speaker ONLY, etc.)

WHAT ARE YOUR GUYS’ THOUGHTS AND ADVICE FOR THIS?!?!?! I mean am I just jumping ship??  Is my role as a BLS/IFT that far down the ladder that I am not worthy of the Med Hx or Billing Info (is this ride free?)  Mind you I will be the unit firing up the lights, blowing by traffic, giving the report to the receiving ER and giving compressions if something does happen… What really irritates me is, after bickering she caved in on a lot of stuff she said she “JUST CAN’T” do.  We got a face sheet and a blood sugar! ANYWAYs,  I’d LOVE to hear back.


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## Sasha (Jan 1, 2011)

Did you not have a transfer packet with all that information in it that you could look up yourself without causing a scene and making you both look bad? Did she not have a charge nurse you could go to? Did the pt not have a chart that you could've gone and gotten yourself?

Sometimes they wont do it. Instead of causing a scene that will likely upset your patients/family members and screw you with the rest of that staff, learn to work around it. Quite often if you find the unit secretary, (The chick/dude who sits at the desk and rolls their eyes and goes "Can I help you?" everytime the call buttons beep.) they can print you at least a face sheet. The patient should have an allergy band as well. 

Could you not have taken your own blood sugar?

Contact percautions are most often posted on the door, and the paperwork will tell you why.

Does she still have a foley in? She is likely to be transported with it, if not they can D/C it at SNF.

How oriented was your patient? Was there family there? They most often know a hell of a lot more than the nurse will.

If you do not have a DNR in hand, she's not a DNR.

If they handed you a sealed packet, and the nurse is giving you grief, wait until you are away from the nurse or down in the truck to open it.

Getting into shouting matches with nurse is stupid. Just learn to work around it.

PS, not saying you did it, but often the way an EMT/Medic come in and carry themselves with the patients and/or other staff will set the tone of the call. If you come in like "I'm tough poo, I'm an EMT!" attitude or something or another, the RN will probably not be on your side.


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## Veneficus (Jan 1, 2011)

RanchoEMT said:


> WHAT ARE YOUR GUYS’ THOUGHTS AND ADVICE FOR THIS?!?!?! I mean am I just jumping ship??  Is my role as a BLS/IFT that far down the ladder that I am not worthy of the Med Hx or Billing Info (is this ride free?)  Mind you I will be the unit firing up the lights, blowing by traffic, giving the report to the receiving ER and giving compressions if something does happen… What really irritates me is, after bickering she caved in on a lot of stuff she said she “JUST CAN’T” do.  We got a face sheet and a blood sugar! ANYWAYs,  I’d LOVE to hear back.



You can never win an argument with an idiot. They are not even smart enough to know when they lost.

In my personal experience certain organizations hire the absolute dregs of the healthcare industry. If your supervisor is informed and cool with it, just load the patient up and take him/her. 

If the patient goes south on you, treat them like you would any other unconscious/altered patient you were called to who couldn't answer the same questions.

No matter who is at fault, nothing good ever comes from arguing with nursing facilities, no matter who you are arguing with.

Sounds like the typical day in IFT.

Let it go.


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## Sasha (Jan 1, 2011)

> Billing Info (is this ride free?)



PS, billing info shouldn't matter to you. You're not the biller. They often have that information beforehand, or can call and get it if they dont. I like the face sheet for the name, dob, age, address (Which can also be found on the ID bands with the exception of SSN and address).

Your job is to write the report, let the billing department deal with whether the ride is free or not.


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## RanchoEMT (Jan 1, 2011)

Sasha said:


> Did you not have a transfer packet with all that information in it that you could look up yourself without causing a scene and making you both look bad? Did she not have a charge nurse you could go to? Did the pt not have a chart that you could've gone and gotten yourself?
> 
> Sometimes they wont do it. Instead of causing a scene that will likely upset your patients/family members and screw you with the rest of that staff, learn to work around it. Quite often if you find the unit secretary, (The chick/dude who sits at the desk and rolls their eyes and goes "Can I help you?" everytime the call buttons beep.) they can print you at least a face sheet. The patient should have an allergy band as well.
> 
> ...



-NO PAPER WORK...
-San Bernardino County: EMT's Not allowed to take Blood Sugar
-No Family, Spanish Speaking Only, Not Oriented(Nurse states Normal, after arguing)
-Nurse states she is a DNR, Crew Requests DNR, Nurse states is electronic and she WONT PRINT, Crew states then it doesn't exist outside your hospital.
-Contact Precautions, Non Stated (Still Not going to assume NEthing)


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## Sasha (Jan 1, 2011)

> -NO PAPER WORK...



So you transport without any paperwork to bring the recieving facility? They'd kill us if we showed up without a packet even if everything had been "faxed".

Think. If you were doing 911, would you know if the patient was on contact isolation? No? Then pretend it's 911 and you don't know if that wound on their back is festering with MRSA or their poo smells because of Cdiff.

Never never never fight with a nurse. It's unprofessional and makes you look like a monkey. Why did you need a BGL? Was she exhibiting signs of hypoglycemia? 

Did you even try to find the charge nurse or to find the chart? What does it matter how long she's been there or what her name was? 

Like I said, no DNR in hand then she isn't a DNR.


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## emtashleyb (Jan 1, 2011)

I would have just found the charge nurse and asked nicely to see the chart. Fighting is never a good idea. It makes you look unprofessional and sometimes as nice as it feels to tell someone they are stupid they just call your boss and complain. I've ran into this problem with a hospital here they freaked when I tried to open the transfer packet. I just said okay im sorry with a smile and opened it when I got in the ambulance


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## RanchoEMT (Jan 1, 2011)

jesus H... Ok. Objectively.


Sasha said:


> So you transport without any paperwork to bring the recieving facility? They'd kill us if we showed up without a packet even if everything had been "faxed".


Hello.



Sasha said:


> Think. If you were doing 911, would you know if the patient was on contact isolation? No? Then pretend it's 911 and you don't know if that wound on their back is festering with MRSA or their poo smells because of Cdiff.


Why cant a healthcare proffesional notify another that an extra precaution is to be taken when handling a patient?



Sasha said:


> Never never never fight with a nurse. It's unprofessional and makes you look like a monkey. Why did you need a BGL? Was she exhibiting signs of hypoglycemia?



Never Never fight with anybody. Fighting is bad, mk.
Its required with my company when the Pt. is a diabetic to get a BGL at time of transport. (Note: Patient doesn't speak english)  After going back and forth with the nurse we were allowed the privilege of knowing she was a diabetic.



Sasha said:


> Did you even try to find the charge nurse or to find the chart? What does it matter how long she's been there or what her name was?


Charge Nurse Found. Charge Nurse States: "We Don't give out that information." which is Bull. Gotn it before this incident. Gotten it after this incident. questioned other case managers, nurses, etc. its given.



Sasha said:


> Like I said, no DNR in hand then she isn't a DNR.


Then we agree..


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## Veneficus (Jan 1, 2011)

RanchoEMT said:


> Its required with my company when the Pt. is a diabetic to get a BGL at time of transport.



If you know, under what authority or consent is your company mandating  medical procedures?

I am a bit disturbed by this revalation as it looks like an often unindicated procedure I would bet is not done for free.

The other issue is a patient can refuse any or part of medical care, if they accept a ride and are told they "have to have a a glucose check" that doesn't seem like good faith consent to me. 

Moreover, a language barrier does not automatically grant consent for treatment. 

I am sure you are just following the policy that your employer imposed upon you, but I was really wondering if you had some insight on it you would share?


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## RanchoEMT (Jan 1, 2011)

Veneficus, good question(mandating medical Procedures), I don't know. I will find out though. On my end my end its supposed to be something like knowing the most about your patient so you can effectively do the most for your patient.  The Real reason i'm sure has a lot of zeros behind it. $$$$
But i like money too, which equates to i like job, which further means i like BGL @ time of transport.


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## Hockey (Jan 1, 2011)

First, who or what is this "U" you keep mentioning?

Second, lose the attitude.  The nurse may of been inept, but it gives you no right to go act the way you did (If you really even said any of that).  

Third, I'm going to quote your OP in a moment and give you my opinion (In *BOLD CAPS)*





RanchoEMT said:


> Well as the Title may give away, I was working BLS/IFT the other day picking up out of a Kaiser, in San Bernardino County.  Our Patient was originally admitted for CVA a few days prior and was being transported across county lines to a nursing facility approximately 40 miles away. *COOL*  Upon contact with the sending Nurse and after asking for a report, the Nurse states that she has never given a report in her entire time working at this facility and does not feel it necessary to tell the crew(Myself/Partner) now. *BS FLAG GOES OFF.  HAVE YOU THOUGHT MAYBE ITS THE WAY YOU APPROACHED HER?*  NOR, does she give our crew any type of face sheet for billing. *DON'T NEED IT FOR BILLING* We are given a paper with her diagnosis (Only) and her prescribed Medications.
> -A summarized Version-
> I ask her: "How long have u worked here?"  *AS SHE SAID..WHAT DOES THAT HAVE TO DO WITH ANYTHING?  YOU COME OFF WITH THAT ATTITUDE AROUND HERE YOU'RE LUCKY TO EVEN HAVE A JOB*
> Nurse: “What does that have to do with anything?!”
> ...



You need to seriously relax.  Sure she may of been incompetent but does that give YOU the RIGHT to act the way you did? Absolutely not.  You write it up, move on.  If you did not feel comfortable with the transfer of care, you do not transport the patient.  Did you ask for a supervisor?  Did you even write this incident up?  Its not the end of the world.  You're LUCKY you aren't out of a job right now.  EMT's are a penny a dozen.  You need to get thicker skin and learn to be more professional.  How many years have you been doing this?  This wasn't an advanced ALS transfer.  It was a basic transfer


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## spike91 (Jan 1, 2011)

I personally wouldn't have accepted care until getting a full report. I'd file a formal complaint on that, the nurse put you guys in a VERY bad situation there.


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## Hockey (Jan 1, 2011)

Since I can't edit (if a administrator wants to add it in the OP thats fine)



She may of been a great nurse who was just rattled or stressed from something earlier.  You don't know...
Here...good read: http://ambulancedriverfiles.com/2010/12/stains/


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## 18G (Jan 1, 2011)

I definitely understand where the OP is coming from. I'm convinced all nursing staff at nursing facilities across the country are idiots who are totally clueless. If anything its the nurse who thought she was all that and did not feel the need to comply with normal transfer of care procedures. I think legally she had an obligation to properly transfer care. As a healthcare provider you can't just dump a patient on someone else without properly informing them about the patient. 

I don't know if an actual argument pursued or not... the tone the OP set doesn't sound like a full fledged argument. I can push buttons and imply much very calmly to make my point with someone. There does come a point where you do need to walk a way. But there is also a point where you serve as a patient advocate and you need to be firm in ascertaining what information you need for your patient transfer. Were not puppets that just do what were told (well, some ppl obviously are).  

When a patient is already in a medical facility with known diagnoses and infectious diseases, that info NEEDS to be relayed. It is NOT the same as being at someones home or on a street corner. Again, there is an obligation on behalf of the originating facility to present this to the EMS crew. 

I would recommend always asking for the info. If the nurse refuses then ask for her supervisor. If that gets you no where try the unit clerk, call ur supervisor and document the refusal of the nursing facility to comply with your request. Do not raise your voice or allow an actual argument to ensue.


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## Outbac1 (Jan 1, 2011)

I've had a few RNs not want to give report. I politely explain why I need it. This usually works. If not I don't take the pt and call my supervisor. This you did and they told you to document it and take the pt. Now you have a dilemma. Keep your job and take the pt. (This also lets the stupid nurse win and she won't learn anything), or stand your ground and advocate for proper pt care. I can't fault you for whichever decision you take.

 Others have already written how to better handle the situation and I'll let that stand.


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## mgr22 (Jan 1, 2011)

I understand your frustration, but I think your opening remark to the nurse ("How long have U worked here?") was provocative, and not likely to promote cooperation.


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## willings (Jan 1, 2011)

As ridiculous as that nurse was, it still gives you no right to argue. My advice would be transport, document the crap out of it and report it to your supervisor. 'nuff said!


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## Shishkabob (Jan 1, 2011)

When asked "Why", state "Do I bring you a patient without giving you a report?".    If they still refuse, ignore them, open the envelope even if they protest, or ask a doc if you can find them.  If they have a problem, they are more than welcome to call my supervisor and explain why they don't want there to be proper patient care.  


I've done it before.  I had a nurse absolutely refuse to tell me anything about the patient claiming an "ongoing criminal investigation" and that I had no right to know anything about the patient, I was just there to transport.    I said thanks, took one step to my right and asked the doc, who gave me the whole report than dressed her down.


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## willings (Jan 1, 2011)

Linuss said:


> When asked "Why", state "Do I bring you a patient without giving you a report?".    If they still refuse, ignore them, open the envelope even if they protest, or ask a doc if you can find them.  If they have a problem, they are more than welcome to call my supervisor and explain why they don't want there to be proper patient care.
> 
> 
> I've done it before.  I had a nurse absolutely refuse to tell me anything about the patient claiming an "ongoing criminal investigation" and that I had no right to know anything about the patient, I was just there to transport.    I said thanks, took one step to my right and asked the doc, who gave me the whole report than dressed her down.



Lol another affective way to handle the situation.


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## RanchoEMT (Jan 1, 2011)

hey Linuss, I've followed a lot of your posts and i regard you as someone with a lot of know-how and experience that I could benefit from. I've summarized alot and i assure you i was not the first to give attitude during the interaction Obviously I had a temper with the nurse, maybe not so much so as everyone is reading into, but how far would you have gone to get patient info if theres no family, no doc in sight, Pt. non-english speaker, and NO Paperwork(including transfer packet)???

I guess what I'm asking is how far can you take the Patient Advocate Road before you have to walk away?


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## WTEngel (Jan 1, 2011)

Everyone has bad days. In this case I am more frustrated with the nurse's lack of professionalism than your own. Would she have transferred the patient to the oncoming nurse and refused to give report? Would she have transferred the patient to another floor without report? Nursing claims to be so professional (and in 99% of cases they are EXTREMELY professional) and in this case I see a flake who for whatever reason had a chip on her shoulder.

It could have been the attitude you approached her with, it could have been she was having a bad day, it could be that she has a poor opinion of EMS professionals (which you probably didn't help,) or it could be that the nurse was just a complete loser.

I have run into issues similar to this with referral facilities on a few rare occasions, and in most cases immediately when you see that the referring staff is being standoffish, it is because they themselves have a lack of knowledge on the patient. At that point, put the principal of the issue aside (the fact that they are refusing to give you info or doing it defiantly) and keep your eye on the prize. Seek alternate ways of getting your patient info such as other healthcare workers, physicians, unit clerks, family, etc. 

It also helps that I always roll with a nurse (that's just the way I roll...) and in the rare instance the referral staff is being obstinate, I can usually just say, "OK, no problem..." step inside the patient room and allow my nurse partner to have a try at speaking with the referral nurse. 

The bottom line is, everyone deserves to be treated as a professional, even if they may not be acting like a professional. Do your best not to escalate the situation, discuss the matter with the charge nurse, your supervisor, and medical director if necessary. Document well, and as always, be as flexible as you can.


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## rescue99 (Jan 1, 2011)

*Sheesh....*



> WHAT ARE YOUR GUYS’ THOUGHTS AND ADVICE FOR THIS?!?!?! I mean am I just jumping ship??  Is my role as a BLS/IFT that far down the ladder that I am not worthy of the Med Hx or Billing Info (is this ride free?)  Mind you I will be the unit firing up the lights, blowing by traffic, giving the report to the receiving ER and giving compressions if something does happen… What really irritates me is, after bickering she caved in on a lot of stuff she said she “JUST CAN’T” do.  We got a face sheet and a blood sugar! ANYWAYs,  I’d LOVE to hear back.



No information, no transport. If ya can't bill, ya can't transport. This is not an accident, nor is it an acute illness.....this was a planned scam IMHO. The sad thing is the supervisor actually agreed with the so-called nurse? Not acceptable and explains the sub-par wages we receive in EMS. Not to mention the the nurse was simply incompetent. No wonder so many EMS professionals get the impression that "highly educated" nurses are such idiots!


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## rescue99 (Jan 1, 2011)

*I agree*



spike91 said:


> I personally wouldn't have accepted care until getting a full report. I'd file a formal complaint on that, the nurse put you guys in a VERY bad situation there.



You are the most correct so far. The situation happens all too often to crews no matter how they approach staff. Fact is, it should never happen, period.


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## rescue99 (Jan 1, 2011)

emtashleyb said:


> I would have just found the charge nurse and asked nicely to see the chart. Fighting is never a good idea. It makes you look unprofessional and sometimes as nice as it feels to tell someone they are stupid they just call your boss and complain. I've ran into this problem with a hospital here they freaked when I tried to open the transfer packet. I just said okay im sorry with a smile and opened it when I got in the ambulance



Sounds like a typical day at the DMC  Sometimes there isn't much else to do but play the game.


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## DrParasite (Jan 1, 2011)

Linuss said:


> When asked "Why", state "Do I bring you a patient without giving you a report?".    If they still refuse, ignore them, open the envelope even if they protest, or ask a doc if you can find them.  If they have a problem, they are more than welcome to call my supervisor and explain why they don't want there to be proper patient care.
> 
> 
> I've done it before.  I had a nurse absolutely refuse to tell me anything about the patient claiming an "ongoing criminal investigation" and that I had no right to know anything about the patient, I was just there to transport.    I said thanks, took one step to my right and asked the doc, who gave me the whole report than dressed her down.


BINGO!!

If you don't get a report, don't get any paperwork, then don't transport the patient.  don't get into a screaming match.  ask for their supervisor.  maybe you will get someone who has a clue, maybe not.  either way, be professional.  contact your supervisor.  advise them of the situation.  let the boss give you guidance.

For those that say "just transport the patient and deal with the idiot later" well, that's a HUGE liability on your end.  you know you don't have the proper information, you have no paperwork, and you are still going to be "good company men" and transport the patient to wherever he is supposed to go?  those who say to do it are more retarded than the nurse.  If you ever want to be respected in this field, you need to know when to stand up to other providers when they are in the wrong, and not be pushovers and do what the nurse says just because she's the nurse.


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## njff/emt (Jan 2, 2011)

i agree with parasite, i too have had the misfortune of incountering with those types of "nurses"., granted everyone has a bad day but since you are the healthcare professional recieving the pt you have every right to know what's goin on with them., i've also had some ask me why i needed the information because they've never been asked for it before, i simply say that i needed it just in case the pt crashes we have info for the hospital., if they still refused i called my dispatch and told them the situation., plus some facilities have contracts with other companies so they may already have all the info., all in all you just got to let certain things go and not let it bug you., trust me there are worse things than a nurse with a nasty attitude


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## johnrsemt (Jan 2, 2011)

No one has mentioned the one thing that would help out alot,  and that I have had to do in the past:   Call the receiving facility and get a report from them;  if asked state that the paperwork given was mangled due to copier issues or something else that doesn't assign blame.  and the sending nurse is new to this patient and can't give a report

   the receiving facility has gotten a report from the sending facility before your arrival;  so make use of it.


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## Sandog (Jan 2, 2011)

All the while, amongst all the bicker, one must do what is best for the patient. Poor sick guy has nothing to do with your argument de poids...


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## MusicMedic (Jan 2, 2011)

Unfortunately this scenario is all too common in southern CA SNF's Transports....

although i havnt been in the situation with not having any paperwork... ive been in plenty of situations were the Nurse refused or did not give me an proper report.. luckily i had the paperwork and so i would look that.. 
and most of the time i just tell the Nurse in the ER/Urgent care that the Nurse at the SNF didnt give me a proper report and they usually call the Facility and have a stern talking to.
Ive had a Nurse not tell me that they had any Iso Contact/Infection Control and ive read the paperwork and found out they had Hep-C (or in another situation the patient told me they had HIV)... 

In regards to your situation i would have called the supervisor (like you did) and also refused transport until i got all proper paperwork...


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## Veneficus (Jan 2, 2011)

MusicMedic said:


> Unfortunately this scenario is all too common in southern CA SNF's Transports....
> 
> although i havnt been in the situation with not having any paperwork... ive been in plenty of situations were the Nurse refused or did not give me an proper report.. luckily i had the paperwork and so i would look that..
> and most of the time i just tell the Nurse in the ER/Urgent care that the Nurse at the SNF didnt give me a proper report and they usually call the Facility and have a stern talking to.
> ...



This happens all over, not just in CA. It is a fairly common in my experience.

It is best to try and work around it. Eventually I got to the point where I didn't want a report from the facility, just give me the packet and I will figure it out on my own, it'll be quicker and more accurate.

The best is when you ask to speak with the nurse and the LPN tells you she is a nurse, but cannot tell you the history, meds, or allergies on the patient. 

"Can I please speak to the real nurse now?"

Who usually relates she just came on shift" and doesn't know anything about the patient because she has not got around to them yet because of all the billing paperwork she is obligated to do before seeing patients.

The winning trifecta is when it is a temp agency nurse who has never been there before and likely will never be there again. 

I could go on for years about nursing home stories. 

Don't get worked up. It's not worth it.


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## JPINFV (Jan 2, 2011)

On the general topic of reports, I think it all revolves around having a realistic idea of how much report to expect. Transport paperwork is, normally, a gold mine of information, and yea, I can understand being expected to look at the paperwork for a lot of the history/allergies/meds. Yes, I can understand a nurse seeing little need to cover a 5 page med list, especially when the provider has a good chance of not understanding the difference between an ARB and a ACEI. 

Similarly, when it comes to a communicable diseases, as Dr. ExMedic once put on JEMS Connect, there are two types of concerns. There are the diseases that are major. This is your HIV, Heps, etc, and then there's the diseases you might actually catch, such as MRSA, the flu, TB. Yea, HIV is bad and communicable, but unless you feel like playing with blood or having sex with the patient, your actual risk of HIV is pretty low. Same with Hep C. You aren't going to catch Hep C by shaking the patient's hand without gloves. However, look at the paperwork. All of those communicable diseases should be listed and anything acutely respiratory should have you taking precautions regardless of what the nurse tells you. Why would a patient with a productive cough at a nursing home need additional precautions than the patient coming from home? Shouldn't they both have respiratory precautions taken? Pull on the big EMT pants, perform an assessment, and decide on precautions as indicated. 

Sometimes you just need to take a step back, examine what information you have, including the ability of the patient to act as their own historian, breath, and be the bigger person at the pissing match. Sometimes it's not worth the argument, and it's *never worth the argument just to prove yourself right.* If you need to submit an official complaint, do it through the official channels after the transport instead of trying to hash it out on scene. However the OP's issue of neither proper report nor proper paperwork makes it a difficult situation than it normally is.


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## RanchoEMT (Jan 2, 2011)

Hey guys, thanks to all so far for the input. Of course Hindsight is 20/20 and its real easy to say you should have just did this or done that, but i guess learning comes from failures sometimes..  Maybe i'll be a bit more careful and level headed about things next time now that I've been there/done that(Argued with a Nurse), i'm sure i'll have plenty of opportunities to practice!  I'm very appreciative of the opportunity to vent and seek advice from you guys and this website.  We Are all here to seek consultation, Learn and improve ourselves/help improve others... Anywho, this is getting too fluffy. 
Thanks.

....Seriously Tho, give me a *&%@ Blood Sugar!


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## RanchoEMT (Jan 2, 2011)

...and for the Purpose of further discussion, perhaps i was too vague,
the only thing we got from the nurse was a paper that stated the patient's current diagnosis(admitted for CVA), and a list of prescribed medication's coming from this facility only... Not a Med Hx nor Medication Hx.

Lets be perfectly clear, because i can tell by the previous posts that i have not yet been.  There is NO PACKET of information. NO PAPER that has the information the crew was asking for. And NO OTHER physical thing* with which to refer to the patients medical Hx or any other type of info for that matter.  This lack of info....This COMPLETE lack of info is the topic of discussion. Just to be Clear.


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## usalsfyre (Jan 2, 2011)

If you learn a little about pharmacology you'll fine you can't figure out a fairly good medical hx.


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## rescue99 (Jan 2, 2011)

johnrsemt said:


> No one has mentioned the one thing that would help out alot,  and that I have had to do in the past:   Call the receiving facility and get a report from them;  if asked state that the paperwork given was mangled due to copier issues or something else that doesn't assign blame.  and the sending nurse is new to this patient and can't give a report
> 
> the receiving facility has gotten a report from the sending facility before your arrival;  so make use of it.



The nurse is still required to transfer care, which includes a report. I do hope the OP had common sense enough to do his talking out of ear shot of anyone, most especially a patient.


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## Veneficus (Jan 2, 2011)

rescue99 said:


> The nurse is still required to transfer care, which includes a report.



While I fully agree with you, I will bet dollars to doughnuts the nurse didn't see it that way.

One of the things that always struck a nerve with me is that many nurses are told something along the lines that techs are not licensed providers and as such are only around to carry out orders and cannot have care transfered to them.

Also when you think about it, while a nurse can delegate to a tech, what would happen to a paramedic who transfered care to a lower capable provider?

A nursing home patient needs nursing care.

So I can see where many feel that the actual report and transfer of care is not between facility and IFT, but facility and facility, with the IFT being techs who drive the patient in a similar form of pushing the bed from one section of a hosital to another. 

In the event of a decline in the patient's status, those same providers would have the responsibility to see the appropriate care is given. It is easy for EMS providers to think that care is the ED, because that is what is drilled into them. 

The fact remains the ED is not definitive care. Nor was it ever meant to be. Many chronic medical problems cannot be served by the ED, and as such direct transfer of the nursing home patient to the most appropriate healthcare is superior than a trip to the ED so that the ED has to run all kinds of tests and do what the NH could have.  (Disclaimer that sometimes the ED is the proper destination) 

Patients who are being transfered between facilities with the exception of an ED are not likely to just code out and die. (Sorry to take that away from all the IFT folks who were probably hoping for that in order to use something taught in EMT or medic school)

Trouble breathing, Low or high BP, large masses in the neck or abdomen, etc, etc. are conditions these people live with everyday and probably have for sometime. They are not emergent as EMS providers are taught because they are not acute and they are being properly managed. 

Now if I take you out of your home suddenly and you don't understand why, you might have a little bit of stress response. Rapid breathing, heartrate, etc. But it certainly isn't an emergency. 

The patients most likely to code on IFT are already DNR patients. In which case there isn't much going to be done anyway.

Most providers outside of EMS have no idea about EMS, or EMS trained IFT providers. They don't see it as transferring care, they don't understand what the providers do or are expected to.  What EMTs/paramedics are or do was given absolutely no time in my medical school despite the facts the school teaches paramedics and medical students ride with paramedics as mandatory clinical time. You must realize in a majority of both medical and nursing schools if EMT/paramedics are even mentioned that is probably special. 

I don't agree with it, but it is what it is.


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## Journey (Jan 2, 2011)

We give enough report for what we believe is appropriate for a BLS level of care just like we do our CNAs, transporters and ED technicians. EMT students do at least one clinical in the hospital and we know they are very limited in what they can do or their medical education. We also know they will only be doing the basic vitals and not pushing any medications.   

Some RNs have given a complete report just as they would and probably already had to the RN at the other facilty. But, the problem then comes when  the RN from the other facility calls back wanting a clarification because the EMT to RN report was passed on as the patient go 200 mg of Lasik and was in V-fib prior to departure instead of 20.0 mg of Lasix and hx of A-fib.  The EMTs may try to grasp more than they are prepared for which can result in a report that might not be accurate. We also had EMTs refuse transport because of something in the history 30 years ago and has not been an issue since that time.  TB is an example. Even after several attempts to convince them it is no longer a problem since PPDs and CXRs are done, it doesn't matter. PPD screens are now required in many LTC facilites.  MRSA is another one that scares EMTs as mentioned but it does give the RNs staff and indication of how little might be known about patient care and infections. Unfortunately the RNs do not have alot of time to spend going over what should have been included in the curriculum for EMS as it is for our technicians and CNAs.  Please recognize standard patient precautions. You should notice if there a sign on the door and isolation stuff by the room. C-diff, influenza and TB are the big ones now which do require special consideration.  Others like HIV would be a concern if you are going to play in their blood or have sex with them in your truck as often seen on TV shows. Neither are advisable. 

More often than not, the RN or LVN at the other facility has received a full report along with a case manager file.  If the patient is diverted to an ED, either the sendng or rec'g facility may be contacted for the appropriate paperwork and information to prevent any miscommunication of condition, hx and meds.

However, I do agree that the code status paperwork should accompany the patient on BLS transfers along with just the essentials of care similar to what is required for intrahospital transport.  

If it is a higher level of care such as an ALS with a Paramedic or an RN, a more thorough report will be given since treatment is being continued throughout the transport. 

Also, for billing, the Case Manager will often do the arrangements for transport with a pre-approval from the insurance before the ambulance will even be dispatched. There have been times where the ambulance has been delayed or canceled because of the lack of approval for payment has been denied sometimes due to missing information or a clerical error.  So until your ambulance service sees the money, some patients don't get transported. This can also be part of the arrangements when ambulance services get contracts with various hospitals and LTC facilities. 

One more point, just because a patient is a DNR, we still treat up until they code if we feel it is a reversible problem unless there is also a "do not escalate care" order along with the DNR.  However, EMS may only be able to take the DNR order and do what their protocol states. We have ran into that situation also from the point of not doing anything including providing oxygen for someone who is a DNR (not comfort care) to doing everything because the order was not exactly how their protocols stated a DNR order should be.


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## Akulahawk (Jan 2, 2011)

To make life easier for RNs so that they don't have to think about what an EMT needs or a Paramedic needs (because many times the RN doesn't know the difference) I just ask the RN to give report as if to another RN on another floor, unit, or shift. I'll also ask for a transfer packet. I'm going to be able to keep up and then some. Then again, I have a broader education than most medics. It probably comes as a surprise to them when it becomes obvious that I know what they're talking about...

Now why do I want to know stuff? Simple. I'm protecting my own license. I need to know that the level of care that I can provide is appropriate for the patient. There have been times where I've had to advise the sending facility that I can't accept the patient over something as simple as the patient having an IV fluid that is out of my authorized scope of practice. When that happens, they're also advised of what fluids I can monitor during transport, and if changing to a different fluid during transport is not possible, then I have to advise that the patient needs to go by CCT... Most of the time, the fluid is changed to something within my scope of practice. 

Stuff can be that simple...


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## medicRob (Jan 2, 2011)

RanchoEMT said:


> Well as the Title may give away, I was working BLS/IFT the other day picking up out of a Kaiser, in San Bernardino County.  Our Patient was originally admitted for CVA a few days prior and was being transported across county lines to a nursing facility approximately 40 miles away.  Upon contact with the sending Nurse and after asking for a report, the Nurse states that she has never given a report in her entire time working at this facility and does not feel it necessary to tell the crew(Myself/Partner) now.  NOR, does she give our crew any type of face sheet for billing. We are given a paper with her diagnosis (Only) and her prescribed Medications.
> -A summarized Version-
> I ask her: "How long have u worked here?"
> Nurse: “What does that have to do with anything?!”
> ...



I haven't read anything more than this first original post. However, as an RN I will say that this nurse was in the wrong.. While you cannot expect her to give you every little detail you want, it seems that everything you asked for was reasonable. Take this up with her charge nurse. Explain to the charge nurse what kind of information you requested, why the information is important for you in transport, and the nurse's actions in a matter of fact way, not in a "Well I hated the way she did this" kind of way. 

While there are RN's who go to nursing school to specialize in palliative care and gerontology who are quite competent, there are some nurses who are working at nursing homes simply because they could not cut it in a medical center. However, the same is true of any profession really.


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## rescue99 (Jan 2, 2011)

Veneficus said:


> While I fully agree with you, I will bet dollars to doughnuts the nurse didn't see it that way.



Yeah, yeah.....ain't it always the way!


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## JJR512 (Jan 3, 2011)

Having transported a few thousand IFT patients myself, for three different companies, here's what I have to offer.

Suppose you are working 911 and get called to a street corner with a man down. You get there and find the unconscious man. Somebody found him and called 911; nobody knows what happened to him, who he is, why he's unconscious on the ground, or how long he's been there. Do you argue with the bystanders, demanding to know why they can't tell you anything?

In a situation like this, just ask the nurse for the info. If they can't or won't give it to you, call your dispatcher or supervisor and explain that the facility is unwilling to provide the info, and ask your company if they have enough info for billing. After all, your dispatcher didn't send you there on a whim. Somebody at that facility called your company to arrange for this transport, and all the info necessary for billing may already be at your company. So find out if they have what they NEED, and ask if they want you to transport or what.

Some facilities are now sending information to other facilities electronically. This is to save the cost of paper and also to reduce the chances of private information falling into the wrong hands. Like it or not, but many places feel the transport team doesn't need to know the information. And the truth is, the transport team probably does _not_ really need to know it. If your patient "goes south" then you tell the ER whatever you know, and it's the same as that random guy found unconscious on the street corner. You can tell the ER where the patient came from and maybe they can fill in the ER on some of the details, maybe that's a waste of time and it certainly would be easier if they'd just send the info along with you in the first place.

It's not worth getting bent out of shape because you will rarely win these fights. Fighting these battles is _not_ part of the job description or training for the field transport teams, either. If you company doesn't like a facility or the way they work, your company can refuse to do business with them in the future.


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## JPINFV (Jan 3, 2011)

JJR512 said:


> After all, your dispatcher didn't send you there on a whim. Somebody at that facility called your company to arrange for this transport, and all the info necessary for billing may already be at your company. So find out if they have what they NEED, and ask if they want you to transport or what.


It's really going to depend on the company. At my first company I've been in dispatch when calls for discharges came in, and general all that was gotten at that time was location, destination, name, diagnosis, and insurance company. So, sure, you aren't being dispatched on a lark, but dispatch isn't always a limitless fount of information. 



> Some facilities are now sending information to other facilities electronically. This is to save the cost of paper and also to reduce the chances of private information falling into the wrong hands. Like it or not, but many places feel the transport team doesn't need to know the information.



It also doesn't help when crews accidentally drop the face sheet in the parking lot, which forced one hospital to change the social security number on their face sheets from 123-45-6789 to XXX-XX-6789.


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## MrBrown (Jan 3, 2011)

A guy with 100 hours of training and somebody who sounds like they got thier nursing qualification in the Weet Bix box .... hmmm, Brown thinks that combination just can't end well no matter what is done.

Our Patient Transfer Officers get three days of medical training.  Why? Because they are Patient Transfer Officers and not Ambulance Paramedics, they transfer patients.

Now Brown may or may not be a B2 BN qualified intensive care RN (and/or HEMS Doctor) but lets say you roll up to take a patient who is being discharged from the ICU home and Brown hands you a tree worth of notes and says something like "this is Sam, ten days post sepsis, was on ceftriaxone, lorpressor, dopamine and we had him in an induced coma for ten days, really hard to wean off the vent, lactate and WBCs were sky high, did have leukocytosis and neutrophilia however last CBC was normal.  We have arranged outpatient labs in a week and an appointment with his GP"

Is that going to change anything during your ride home? Is knowing his sedementation rate or medical history from the eighties going to change how you give him some oxygen if he needs it or zap him with the AED? No.


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## WTEngel (Jan 3, 2011)

Whether or not a full patient report is given is not the decision of the nurse any more than it is the decision of the paramedic or other health professional to decide how much info the nurse needs for their report.

Full patient report at transfer of care is a patient safety goal and the standard of care, whether you think the person you are transferring care to understands the report or not.

It is a little worrisome to me that people here think it is acceptable for them to pick and choose what they report at transfer of care. A full report, every patient, every time...anything less endangers the patient and your license.


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## Journey (Jan 3, 2011)

WTEngel said:


> Full patient report at transfer of care is a patient safety goal and the standard of care, whether you think the person you are transferring care to understands the report or not.
> 
> It is a little worrisome to me that people here think it is acceptable for them to pick and choose what they report at transfer of care. A full report, every patient, every time...anything less endangers the patient and your license.



As an RN do you spend 20 minutes giving a report to an EMT-B for every routine transfer?  Do you cover the entire medical history and hospital stay? Do you review all the patient labs? Do you cover every medication with the last times given? I&Os? Do all the EMT-Bs interact with questions about your report to ensure they understand everything you have stated? Do they make their own detailed notes on everything you have told them?  Are all the EMTs eager to sit through a 20 minute detailed report or would most prefer to get the bare bones version and get on their way? 

ALS and CCT reporting will be different if there are providers such as an RN or a Paramedic on those transports. But even then, one can see the difference in comprehension or expectations of the reporting.  There is another thread  on this forum that had this comment.



> I think IFT is best served by EMS but would be better served if additional education was directed at transporting patients inter-facility.
> 
> I'll use myself as an example, I started working for an ALS service (FD) that does IFT from a rural medical center to actual hospitals with more capabilities. The hospital sends their IV pumps yet there is no formal in-service training whatsoever on the IV pumps. Granted, the pumps and drips are already set but the Medic needs to know how to troubleshoot the pump, clear errors, etc. I at least took the effort to talk to the nursing staff in the ED and got a quick "review" of the pumps and asked for the number to the medical centers education dept.



This is an ALS service and it seems there are a lot of expectations placed both on the Paramedic and the RNs.  These RNs should also not be expected to be educators for the Paramedics at the time of a transfer of a patient. 

Some Paramedics will understand some of the labs, medications and disease processes but sometimes, even with a very thorough report they will not get that much out of the report except the patient has to go to another hospital and the RN is reponsible for setting everything up.  For most, it will be on the sending hospital until the ambulance drops the patient off at the accepting facility.   This also puts the sending RN in the sending facility in a bad situation and it is possible this is not the best crew choice but may be the only choice in town.  

It probably is not the Paramedics' fault but the way their curriculum has prepared them and some may not know what their own expectations are to know what should be acceptable and what is not.


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## JJR512 (Jan 3, 2011)

Journey said:


> As an RN do you spend 20 minutes giving a report to an EMT-B for every routine transfer?  Do you cover the entire medical history and hospital stay? Do you review all the patient labs? Do you cover every medication with the last times given? I&Os? Do all the EMT-Bs interact with questions about your report to ensure they understand everything you have stated? Do they make their own detailed notes on everything you have told them?  Are all the EMTs eager to sit through a 20 minute detailed report or would most prefer to get the bare bones version and get on their way?



As someone who has done thousands of BLS IFT transports, I have never had a report take as long as 20 minutes. Not even half of that.

My major concerns were why is the patient here, why are they going where they're going, am I likely going to have any problems and if so what, and is there anything special I need to be aware of. By "anything special" I mean does the patient spit, does the patient say strange things, does the patient prefer to sit at a particular angle of recline, is the patient going to want me to crank the heat up, etc. I don't _ask_ each of those questions; I just ask if there is anything special I need to know about this particular patient.

As for the full details, in my experience, they are all contained the in the charts and reports that accompany the patient. Unless the facility transmits them electronically, but this was rarely the case in my experience. Probably will be a growing trend, though. In fact I only recall the VA facilities being ones that did electronic chart transfers, and only between other VA facilities.

I feel that all I need to know is enough to explain why I was transporting the patient if I need to take that patient to an ER. Why were they in my ambulance to begin with. Basically, a brief summary that I can give to the ER charge nurse when I roll in. The details are all in the charts and reports that go with the patient, and the ER can get them from there. This 20-minute-long super detailed report you're talking about is something I don't feel is appropriate for me, as an EMT-B, because I lack the background to understand most of it, therefore I'm not likely to remember it well and won't report it accurately.


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## WTEngel (Jan 4, 2011)

If it is taking 20 minutes to give a full detailed report on a BLS transfer then you must be taking your time. 20 minutes or more on a CCT is the minimum sometimes.

The point I am trying to make is that it is not the right of the nurse giving report to pick and choose what they feel is important, thus impacting what is and is not included in report. A full report on transfer of care is best practice, a safety standard, and the best thing for the patient. Had the nurse in question here acted the way she had in any of the hospitals I have worked in, she would have been sternly disciplined and counseled about how she should interact with fellow health care professionals (whether the EMT was acting professional is beside the point) when transferring patient care. 

I have participated in CQI and root cause analysis of near misses and sentinel events and many times the ultimate conclusion is that there was a miscommunication, often occurring at the time patient care was transferred. 

To address whether or not the nurse should educate the person they are giving report to if they do not understand something they are saying, if it is pertinent, absolutely. When I give report and transfer care, you better believe if the healthcare professional has questions regarding the patient's condition, labs, or studies, I will clarify it for them. If they don't seem to understand what I am explaining, and it is something that will effect patient safety, then I would be compelled to speak with the charge nurse or unit supervisor and discuss the matter with them. This is not an insult to the provider, but hopefully will prevent them from getting in over their head. The same should be true of nurses giving report to IFT crews. If there is something notable regarding HPI, patient condition, labs, or studies, and the crew does not seem to be getting the picture, then they may not be the appropriate level of care for that patient. Or maybe it is something that just needs to be passed to the person they will transfer care to...

Picking and choosing what information you give to the person you transfer patient care onto is dangerous. If they don't understand or don't care to listen to your patient report, that does not mean you should dumb it down for them. I choose to bring people up to my level, not arbitrarily decide that someone is below me and deserves less of a report.


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## Journey (Jan 4, 2011)

WTEngel said:


> If it is taking 20 minutes to give a full detailed report on a BLS transfer then you must be taking your time. 20 minutes or more on a CCT is the minimum sometimes.
> 
> The point I am trying to make is that it is not the right of the nurse giving report to pick and choose what they feel is important, thus impacting what is and is not included in report. *A full report *on transfer of care is best practice, a safety standard, and the best thing for the patient. Had the nurse in question here acted the way she had in any of the hospitals I have worked in, she would have been sternly disciplined and counseled about how she should interact with fellow health care professionals (whether the EMT was acting professional is beside the point) when transferring patient care.
> 
> ...



You stated "Full patient report".   What do you consider "full patient report" for an EMT-B?  To an RN that means labs, meds and a detailed history.  CCT reports can extend over 20 minutes and then are continued on at bedside as each med and equipment setting is checked during the transfer. 10 minutes probably would not be enough time to cover everything safely.

But, for an EMT-Basic on a routine transfer to the Radiation Therapy center 1 block away, how much time and what would you cover for that transfer?  Do you really think a detailed history and all the medications would be necessary when the center probably has that data and the EMTs would not be pushing any medications at all? 

RNs and/or Case Managers are required to also give a full report to the receiving center.  This is not something that can or should be delegated to an EMT-B.

For the EMT-B and a BLS transfer, 100 hours of training specializing in first aid does not even give them a good anatomy base to understand most disease processes so I fail to see what telling them a bunch of lab numbers would be of value to them. Diagnosis, code status, condition stability and reason for transfer should be adequate along with a face sheet if permitted by the facility depending on security issues.  Many facilities are now utilizing secure electonic transfer of documents for billing rather than the paper system. They may present a transfer sheet which may have an established account number for reference. 

We also don't know the exact details of what happened in this particular incident since we are only reading one side of the story nor do we know what the prior arrangements are between that facility and the ambulance service.  The original poster seems to also  have been having a bad day which probably contributed to the situation. It is very difficult to give a report to someone who also wants to find fault in everything you do just because you are an RN. If you have been an RN for any length of time, this is something you should already have picked up on.  

There is also a difference between active interaction during a report with clarification and that where you have to teach someone to operate an IABP, ventilator, IV pump or how to titrate medications.  You can not always teach someone to be a critical care provider in 10 minutes or even 20 but the transfer may have to go on.  Then it can come back on the sending facility which includes the RN who didn't push enough meds for the Paramedic to get through the transport or didn't tell them everything about the IABP when there should also be a point where the Paramedic should tell his employer or the sending hospital, this transport is out of his comfort zone. But, sometimes the ego also gets in the way.   However, no, it should not be the responsibilty of the RN to teach a Paramedic everything about critical care medicine at the time of the transport. The Paramedic and the ambulance company should realize this and see that a properly educated and trained provider is responding to these transfers. 



> If you company doesn't like a facility or the way they work, your company can refuse to do business with them in the future.



I do agree with just about everything JJR512 has posted except for this. If the ambulance service has a contract with all the Tenet facilities in the area and runs across one problem at one facility, is it really worth it to the ambulance service to flush away a contract of that size over what just could be a personality conflict between two people having a bad day? Several EMTs  might lose their jobs which means trying to get hired with the next service that lucks out and gets the contract.  Go through the proper channels to get a problem solved and you might also find out something about the arrangement between the facilities and the ambulance service that you didn't know before.


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## Sasha (Jan 4, 2011)

> The point I am trying to make is that it is not the right of the nurse giving report to pick and choose what they feel is important, thus impacting what is and is not included in report. A full report on transfer of care is best practice, a safety standard, and the best thing for the patient. Had the nurse in question here acted the way she had in any of the hospitals I have worked in, she would have been sternly disciplined and counseled about how she should interact with fellow health care professionals (whether the EMT was acting professional is beside the point) when transferring patient care.



When nurses give me a full report, I often find myself with a deer in headlights stare that just screams "I don't know half of what you're talking about" I prefer when nurses ask me what I need to know, and I tell them and ask questions. That way we are not going off into "I'm an idiot land" and I can find out what I need to.

I'm not going to say that nurses are more or less educated then EMS providers, but they are educated differently and about different things.


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## Sasha (Jan 4, 2011)

> I mean does the patient spit,



I always love the last minute mention of "Oh yeah, she swings/bites/kicks/hits/spits/pulls hair" while you're partner is in the room trying to get vitals


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## JJR512 (Jan 4, 2011)

Journey said:


> JJR512 said:
> 
> 
> 
> ...



When I said that if your company doesn't like the way a facility is run, I didn't mean just on that one call. Naturally I did not mean that if your company is unhappy about ONE call. I mean if it is an ongoing issue, especially if what the facility is doing makes it very difficult for your company to bill and collect. Of course the company will need to weigh the difficulty they are having with a particular facility with the cost of losing business with that place. If it is a single facility that's not part of a contract and only uses your ambulance service occasionally, but every single time it's a hassle, it might not be a big deal to cut the off, but if it's a major contract that provides a lot of income despite some occasional hassles, it might be in the best interest of the company to keep that contract. The point is, I said the company "can" refuse to do business, not that they _should_.

One of the other points I was trying to make, and I don't think I really got to it much, was that the field crew really should not be arguing with the facility staff. Field crew rarely win these fights. Call your supervisor or dispatcher, explain the situation, and find out what they want you to do.

I come from a customer service background and to me, IFT is much more of a customer service job than an EMS job. An ambulance crew being rude or argumentative is something that can eventually find its way up the chain of command of a facility or chain of facilities, especially if the staff on duty at the time is really good at painting pictures. The field crew needs to remember that they are the public face of their company. They very well can cause a facility decide to drop, or not renew, their contract with the ambulance service, or to place them last on the call list. If an ambulance company loses a contract, people can lose their jobs, because they just aren't needed anymore. And it isn't fair to one's coworkers for them to lose their jobs, and possibly much, much more as a result, because one couldn't keep their temper in check, and couldn't remember that as with any job, it's not what the worker wants that matters, it's what the boss wants that matters.


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## Journey (Jan 4, 2011)

Sasha said:


> , and I tell them and ask questions. That way we are not going off into "I'm an idiot land" and I can find out what I need to.



That is definitely one of the best ways to approach it since it is difficult to keep track of the many different services that come in to pick up patients from the condo courtesy vans, retirement centers, wheelchair or stretcher vans to CCTs.  Sometimes I don't believe EMTs or Paramedics are aware of the many other types of transports there might be in an area. Someone driving a shuttle bus for a retirement residence probably would not need to know labs either or billing information. Hospitals also may have their own courtesy vans to get patients back home after appointments. 



Sasha said:


> I'm not going to say that nurses are more or less educated then EMS providers, but they are educated differently and about different things.



In a hospital or LTC facility attached to the hospital such as a SNF or Rehab center calls a Rapid Response Team for a patient that may be requiring immediate higher care, the RN and Respiratory Therapist responding will each have their own set of questions for their own focus. The Respiratory Therapist who intubates, assists with bronchoscopies, nasally suctions and does arterial sticks may want to know when the patient last ate, if the patient is on heparin or similar meds and platlet count. The RN will want to know the INR. Both will want to know the labs such as CBC and chem panel but with a focus on different values. They will have more questions once they do a quick assessment of the patient and see pitting edema (?diuretics, ?I&Os), sternotomy scar, irregular pulse (?meds, EKG on file), dialysis catheter (?last dialysis), distended abdomen (?BM, meds). cool mottled skin (?rectal temp) etc.  Our CNAs usually know when a Rapid Response team is about to be called they need to get a rectal temp, vitals and have the I&Os ready.  

The amount of information on a nursing flow sheet  can even be a little overwhelming unless you are used to looking at it and so can an RN to RN report. Some patients also come with over 80 years of medical history and some is of importance and some gets left off but may be important later.  Just reading some of the topics on this forum criticizing RNs about being concerned about stuff like BMs, urine output, food, psychosocial issues,  comfort and palliative care shows either a lack of education about the importance of these things or their focus is very narrow. One would not think a Respiratory Therapist would be asking about BMs either but if there is abdominal discomfort or distention, it can interfere with the cardiopulmonary system.  They definitely want details for the dialysis patient such as the last time and the most recent K+ to initiate treatment if needed but then other issues might also have to be addressed which the RN is probably already checking out as well.

When an ambulance team does come for a patient, the chart may be pretty massive even for transfer with months at maybe 3 -4 different hospitals and LTC facilities. There might also be hx summaries from each of these facilities with the patient starting with pneumonia at one, had a CABG, had sepsis and finally had a big toe amputated.  The ambulance crew may pick one hx summary that seems to be the easiest to get some information from. When an RN might try to show them the most recent, the EMTs might just say they only need something to fill in the blanks on their report and don't need all the rest. However, the EMTs will probably type something on this forum complaining about a pushy RN who was trying to tell them how to do their job. But, another RN would thank that RN for showing them the rest of the story. 



JJR512 said:


> I come from a customer service background and to me, IFT is much more of a customer service job than an EMS job. An ambulance crew being rude or argumentative is something that can eventually find its way up the chain of command of a facility or chain of facilities, especially if the staff on duty at the time is really good at painting pictures. The field crew needs to remember that they are the public face of their company. They very well can cause a facility decide to drop, or not renew, their contract with the ambulance service, or to place them last on the call list. If an ambulance company loses a contract, people can lose their jobs, because they just aren't needed anymore. And it isn't fair to one's coworkers for them to lose their jobs, and possibly much, much more as a result, because one couldn't keep their temper in check, and couldn't remember that as with any job, it's not what the worker wants that matters, it's what the boss wants that matters.



Well stated. 

It seems so many forget the customer service part which is why hospital staff get constant reminders and inservices.  It is disheartening to read some of the topics and posts on this forum where the EMTs and Paramedics dislike doing routine calls. That dislike is bound to show to the nursing staff and the patient especially if you hear then next truck in rotation getting a cool trauma call while you get to take someone back to the nursing home.  That nursing home patient  is still a human being and still matters as a customer who also deserves some respect.


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## rescue99 (Jan 4, 2011)

Sandog said:


> All the while, amongst all the bicker, one must do what is best for the patient. Poor sick guy has nothing to do with your argument de poids...



Was the tiff being held in front of the patient? Musta missed that part.:sad:


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## LuvGlock (Jan 4, 2011)

The "base" I work at involves mostly taking pts from a freestanding ER to the main hospital (9 miles away), and the occasional walk-in MI to the cath lab.  Needless to say, since these people are all being admitted to the hospital (usually a tele floor), most are ALS trips.  When we walk in the door, the RN usually spends at least 5 minutes giving a quickie report, and then answers any questions we have.

When I was doing D/C->SNF, my only question of the RN was usually "Anything medically important we need to know?", and that would usually suffice.  That being said, the large majority of those trips were BLS, and the MedNec was usually Dementia, so there wasn't a huge expectation of emergencies during transport.  

As far as your situation goes, I wasn't there, but, I've found that being sugary sweet with RN's will get you a long way.  The same applies to Unit Secretaries usually.  Even when they are total blankety-blanks, I just kill them with kindness and I can usually get what I need. 




Sasha said:


> Could you not have taken your own blood sugar?




How would his own BS help him with pt care?


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## Veneficus (Jan 4, 2011)

LuvGlock said:


> How would his own BS help him with pt care?



You are your first patient


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## JJR512 (Jan 4, 2011)

Journey said:


> JJR512 said:
> 
> 
> 
> ...



There is another aspect as well to what we are both talking about here, and that is work ethic. This transcends customer service experience or any other kind of experience; it has nothing to do with the kind of job one has, just the fact that one is an employee with a boss (supervisor, manager, whatever). As you are talking about, what many employees forget is that they don't go to work to do what _they_ want to do; rather, they go to work to do what the _boss_ wants them to do. If you don't like the job, either find another job, or grin and bear it. Besides customer service, I also come from a management background, as well as a crew-level background before that, and I understand both sides of the employee-employer relationship. And just like you are saying, Journey, I see so many fellow employees getting frustrated and angry at the job, and deciding to do things their own way, or deciding what they will and won't do, and that just is NOT the way it's supposed to work.

That's not to say that employees should just blindly follow orders. Obviously, no employee should ever do what they're told if it's illegal, immoral, unethical, or unsafe. Aside from that, pretty much every job description I've ever seen always includes some kind of mention of "and other duties as needed". Also, if an employee thinks he or she has a better way of doing something, they can mention it to the boss, at the appropriate time, or if they don't understand something, they should ask why. So I'm not saying to just blindly follow orders. But remember there is a time and place for asking questions and it isn't always the exact moment they occur.


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## RanchoEMT (Jan 5, 2011)

rescue99 said:


> Was the tiff being held in front of the patient? Musta missed that part.:sad:



Absolutely NOT.  Crew had NOT made patient contact prior to Nurse vs. EMT.


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## rescue99 (Jan 5, 2011)

RanchoEMT said:


> Absolutely NOT.  Crew had NOT made patient contact prior to Nurse vs. EMT.



I thought not...just making sure I read your concerns correctly. I stand by my original thoughts...nurses are often lacking in when it comes to actual patient care capabilities. It's that null curriculum shining through again!


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## Journey (Jan 5, 2011)

rescue99 said:


> I  I stand by my original thoughts...nurses are often lacking in when it comes to actual patient care capabilities. It's that null curriculum shining through again!




Looks like someone didn't get accepted into nursing school. Too bad. You could have learned alot.


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## rescue99 (Jan 5, 2011)

Journey said:


> Looks like someone didn't get accepted into nursing school. Too bad. You could have learned alot.



Never considered nursing so no, I guess I never have been accepted to nursing school  My degree is in accounting and in just a few more credits, EMS.... but thanks for playing anyway


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