So I got fired...

[JJR512]

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

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

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

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

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

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

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

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

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

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

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

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

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

 

[JPINFV]

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

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

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

California's laws mean nothing to me.

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

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

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

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

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


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

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

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


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

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

 

[Veneficus]

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

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

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

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

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

It is always your responsibility to know your scope. Every person in the hospital has a clearly defined scope. There are authorities in nursing above those in your department. In the event you did not receive a satisfactory answer, you need to pursue the matter until you get a clear answer. Even if it is one you don't like.

In your future endevors never assume because somebody asks you do do something you are permitted to. Often the only reason I know if a nurse is permitted to do something is by asking her to do it and her telling me she is unable to carry out my request because she is not permitted. (which varies not only hospital to hospital but also department to department.)

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

Intending no disrespect, but this is not the proper attitude HawthoRNe. You will find that many facilities limit the total scope of practice from what you learned in school.

I have seen nurses fired and even get dragged before nursing boards for performng procedures they were pemitted in one hospital that they were not in another even though they learned how to do it in school.

Your employer can always choose to limit your scope. You should always research exactly what it is, not rely on hearsay. Just because you never got in trouble doing something before, doesn't make it any less of an offense.

Once I had an MD put a syringe of Viscous Lidocaine on the table while I put a foley in. I didn't think twice about it- I mean its just lidocaine, right?.

Are you trying to say you didn't know if you were permitted to administer a medication and was considering or that somebody set a medication down next to you?

Again, a nurse asked me to so I assumed it was within my scope. Maybe its my fault for not knowing my scope, but if my educator can't even specify it, I don't know who can.

For emphasis, that is absolutely a terrible assumption. The department nurse manager can specify, the nurse manager of the hospital can specifiy,the director of nursing for your area can specify, the director of nursing for the hospital can specify.

There must be a written document available, that spells out what can be delegated and what cannot, and under what circumstances. No reputable company would be without it.In fact I am willing to be no hospital that meets Joint Commision accreditation is without it.

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

You claim again and again you don't know what your scope is, how can you claim you did not exceed it?

Has it occured to you maybe you were fired because managers were starting to think you might be a loose cannon and it was only a matter of time before you got yourself into something major?

This really might be a positive experience that makes you a little more low key so you don't really make a big mistake in the future. Sort of like a "time out."

 

[JJR512]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

[bstone]

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

 

[Veneficus]

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

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

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

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

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

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

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

I am really trying to help you see the problem.

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

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

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

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

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

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

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

I can't stand working under my education level.

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

When in Rome, do as the Romans do.

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

 

[EMS49393]

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

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

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

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

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

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

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

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

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

 

[JPINFV]

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

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

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

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

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

30.04.03.04
A. Each BLS education program shall maintain accurate and appropriate records of:
...
(4) Written agreements with facilities and agencies providing clinical and field experience which include:
...
(b) Scope of practice for the student;

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

30.04.03.05
B. Each BLS education program shall provide:

(1) Didactic instruction which shall impart fundamental knowledge, skills, and attitudes which contribute to the delivery of state-of-the-art prehospital emergency medical care including:

...

(2) Supervised field internship which includes practice of skills while functioning in a prehospital BLS environment.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Maybe the OP thought the RN would be back right away, so there would've been no need to remove the tourniquet. I am willing to assume that the OP had reasons for doing what he did, reasons that made sense to him based on his experience, but I am not willing to assume, as you are, that his reasons were bad.

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

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

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

 

[Hellsbells]

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

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

 

[Jeremy89]

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

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

 

[Akulahawk]

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

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

 

[Akulahawk]

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

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

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

 

[JJR512]

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

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

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

 

[JJR512]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

[8jimi8]

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

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

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

 

[Veneficus]

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

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

 

[Shishkabob]

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

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

 

[fortsmithman]

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

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

 

[dixie_flatline]

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

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

 

[JPINFV]

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

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