Nurse/home heatlh on scene becoming an issue

[TLettuce]

We had a call to a frequent flyer today, normally it is a glf victim requesting lift assist. Today it was simply a lift assist due to general weakness, pt was unable to stand at all. Home health is on scene... but dispatch was notified via a lifealert button :glare:.

We had been called here a lot recently so we already know we want to transport.

So we get on scene, start to gather more info, take vitals, and the home health worker is getting upset at this point, she says things like "well before you take her I need her signature because that's the only way I get paid.". "she always acts like this" "Will you do this somewhere else I am trying to get her food ready". But she does say that she thinks the pt had a seizure this morning.

Eventually she calls her boss (An RN.) and hands the phone to my medic partner out of nowhere. After some talking the nurse decides to show up. And encourages us to take the pt. to the hospital. So great at this point I am happy the nurse is here, but the nurse starts telling the pt that she didn't have a seizure and she just doesn't know what she is talking about...

So we transport w/ pt willing. Even though home health say that she hasn't been to get checked out because she simply won't go. (apparently 10 minutes with my handsome self is all she really wanted) and the home health nurse is already in the er in the room with the er nurse! And the nurse is getting a report from home health, who interrupts my partner and gives conflicting information. The er nurse ignores my partner and the er doc is nowhere to be found at the time. Eventually my partner does get a report off but in what light it is received... who knows.



Just thought I would share this story. We all have had run-ins with other health care workers on scene I'm sure. But I found this particularly frustrating. What would you have done? Similar stories?

 

[bigbaldguy]

I've had a couple of calls where the home health folks have pushed for us to transport so aggressively that I almost think they get paid a bonus if they go to the hospital with the patient (both instances they rode to hospital with us). Then we get there and they make a big deal about how they don't know why we transported. Kinda weird. Overall I've been pretty impressed with most of the home care folks I've run across though.

 

[Shishkabob]

I don't like having at home care on my scene as the majority I've met give the same excuses as nursing homes as to why something wasn't done, most are pushy with telling the patient they "HAVE!" to go, they get in my way, etc etc. (Disclaimer: Yes, there are good ones, but on average, they are like any other non-related 3rd party that happens upon a scene)


If someone on scene is interfering with my job, I ask them to let me do my job. I only ask once. If they don't listen, I tell them to leave my scene. If they still don't, then get PD involved. Interfering with an emergency scene is a crime.



I strive to be nice to everyone on scene, but I hate repeating myself. If I have to repeat myself, you're off my scene.

 

[Handsome Robb]

If someone on scene is interfering with my job, I ask them to let me do my job. I only ask once. If they don't listen, I tell them to leave my scene. If they still don't, then get PD involved. Interfering with an emergency scene is a crime.



I strive to be nice to everyone on scene, but I hate repeating myself. If I have to repeat myself, you're off my scene.

Couldn't have said it better myself. Now is PD going to write the citation to a home healthcare worker? Probably not, but it will get the point across with PD presence alone.

 

[DesertMedic66]

If someone on scene is interfering with my job, I ask them to let me do my job. I only ask once. If they don't listen, I tell them to leave my scene. If they still don't, then get PD involved. Interfering with an emergency scene is a crime.


I strive to be nice to everyone on scene, but I hate repeating myself. If I have to repeat myself, you're off my scene.

Same here. Same thing at the hospital. If they are making it so I can't give a report then they are going to be leaving the patients room. I hardly ever let anyone ride in my ambulance besides the patient and my partner. Then a while after the patient gets to the hospital people will be allowed to visit.

I ask them to leave once. Then I tell them to leave. If its a stable patient then I will show the person getting in my way the door. After that it's PD. and PD doesn't always play nice.

 

[Veneficus]

We had a call to a frequent flyer today, normally it is a glf victim requesting lift assist. Today it was simply a lift assist due to general weakness, pt was unable to stand at all. Home health is on scene... but dispatch was notified via a lifealert button :glare:.

We had been called here a lot recently so we already know we want to transport.

So we get on scene, start to gather more info, take vitals, and the home health worker is getting upset at this point, she says things like "well before you take her I need her signature because that's the only way I get paid.". "she always acts like this" "Will you do this somewhere else I am trying to get her food ready". But she does say that she thinks the pt had a seizure this morning.

Eventually she calls her boss (An RN.) and hands the phone to my medic partner out of nowhere. After some talking the nurse decides to show up. And encourages us to take the pt. to the hospital. So great at this point I am happy the nurse is here, but the nurse starts telling the pt that she didn't have a seizure and she just doesn't know what she is talking about...

So we transport w/ pt willing. Even though home health say that she hasn't been to get checked out because she simply won't go. (apparently 10 minutes with my handsome self is all she really wanted) and the home health nurse is already in the er in the room with the er nurse! And the nurse is getting a report from home health, who interrupts my partner and gives conflicting information. The er nurse ignores my partner and the er doc is nowhere to be found at the time. Eventually my partner does get a report off but in what light it is received... who knows.



Just thought I would share this story. We all have had run-ins with other health care workers on scene I'm sure. But I found this particularly frustrating. What would you have done? Similar stories?

I think this is nothing to get upset over.

Probably a good learning experience in working and playing well with others.

While I appreciate the "I will show everyone I am King!" approach, and under some circumstances have had to resort to that myself, I think it needs to be reserved as a last resort, not a 3 strike policy because you feel the bystander is in contempt of EMT. (similar to contempt of cop)

While the arrival of an ambulance or arrival to a hospital is a rather common thing for us, people not always so exposed generally react with all sort of emotions. It is to be expected, and dealt with in a calm, professional way that takes into account the emotional aspects of the bystanders.

Other healthcare workers and public safety persons will have constant contact with EMS. Everyone has their own needs and procedures. Many times there is a perceived conflict.

By talking the matter through with them, addressing needs and perspectives calmly and openly, everyone starts to understand each other and a mutually benefical plan can usually be found and agreed upon.

Home health needs to be paid. Otherwise they stop coming. Which is bad for the patient and will cause you to have to come more often.

Before flipping out about a nurse talking to another nurse and ignoring you, remember that like attacts like.

EMS, nursing, and medicine all have patient care as the end game. But there are different aspects which are more important to some than others.

When a doctor is receiving a report on a patient, she is more likely to be more interested in the report of another doctor than a nurse or EMS.

When a paramedic is giving report they generally communicate better with other paramedics. (more so than basics)

So why is it at all surprising that a nurse was more interested in what a nurse has to say than what you or your partner had to say?

But as for beating your chest with your fists to show you are the alpha provider, save it, because nobody really cares and it just makes you look like a jerk to people you are going to have to work with for a very long time.

Some advice I place high value on.

"Be careful of the toes you step on today, for they may be connected to the a$$ you have to kiss tomorrow."

-Master Chief Petty Officer Gilbertson, USN

"Always be a friend to your patients and their families. For you would never sue your friend, you would gladly sue your enemy."

-Dr. Roberts

 

[mycrofft]

glf?

 

[JPINFV]

glf?

I'm between GLF is simply missing an "I" or it's "ground level fall."

 

[mycrofft]

Since when does private property become "my emergency scene" in the EMS sense? Not to say it can't, but I could see some really red faces after something like that.
Some examples:
1. Occupied car knocked off road in an accident and lands in my living room? Yes, if anyone is injured..
2. Same car lands in my living room and no one is injured? No.
3. I'm sick at home, my home health aid (HHA) is there, gets excited and calls for you to transport me without my knowledge or consent, tells you I had a seizure or I have Alzheimer's, but reconsiders, and you insist on transporting me? Kidnapping, assault, battery, false arrest, abuse of power while under color of authority, assorted mopery and dopery.

OP, I hear you, a bystander is a bystander, but if it was easy they'd let kids do it. Yes, some nurses have a low opinion of EMT's, and yes "like likes like", but it rankles just the same. Do your thing, be nice to everyone, then come back and post here, "we'll leave the light on*".


(*Tom Bodett)

 

[JPINFV]

3. I'm sick at home, my home health aid (HHA) is there, gets excited and calls for you to transport me without my knowledge or consent, tells you I had a seizure or I have Alzheimer's, but reconsiders, and you insist on transporting me? Kidnapping, assault, battery, false arrest, abuse of power while under color of authority, assorted mopery and dopery.

Outside of licensed medical facilities, and assuming that the HHA does not have some sort of legal recognition as a conservator or power of attorney, then they mean nothing in terms of being able to direct care. However, if the patient is competent, then the patient can choose to receive advice from whoever the patient wants. The sticky situation would be a competent patient and a HHA and EMS crew giving different advice. It may be the EMS crews "scene," but if the patient wants to take advice from the HHA I foresee issues if the crew decides to kick the HHA out because they don't like the advice being given.

 

[Aidey]

Frankly, it sounds like an attention seeking client/patient and caregivers who are used to her games. Sorry if it sounds harsh, but power struggles between staff and clients are nothing new.

It isn't uncommon for us to be called to adult family homes, or by patient's with an in home caregiver for petty disagreements. There is one 20 something year old who calls every time she gets mad at her caregiver and claims her blood sugar is low. We show up, check it, prove it isn't low and leave here there. In fact the last time I was there she was in trouble for throwing something at another resident and secretly called while in the bathroom because PD was waiting to talk to her. There is also the lady who calls every time it is her turn on the chore calendar to clean the bathroom. Or the guy who "falls" and won't get up when he doesn't like what is for dinner.

The lady who avoids her chores has very specific orders in her chart by her care team, including her doctor, outlining when she should be taken to the hospital and by what means. It is part of her treatment/therapy to avoid encouraging the idea that she can get out of things by calling 911. If you didn't know that, you might think her caregivers were uncaring or interfering with her care.

Now as for the behavior at the hospital one of the quickest ways to piss me off is to interrupt me while I'm giving report. If it is relevant info I left out that is ok but it drives me nuts when it is for stupid little stuff, or something I simply hadn't gotten to yet. It is elementary school level behavior, one person talks at a time.

 

[systemet]

Just thought I would share this story. We all have had run-ins with other health care workers on scene I'm sure. But I found this particularly frustrating. What would you have done? Similar stories?

I think it's good to engage the home health people in this situation. They may have valuable information that sheds light on the patient's current condition. They can be especially helpful in describing the patient's baseline status, and identifying what's new today, even if any conclusions they've made as to what's wrong have to be viewed with the normal cautious skepticism.

If they get a chance to pass their information on to you, then they're probably less likely to get in the way later.

If they're interrupting in the flow of the call, then that's a problem -- but is it necessarily a big enough deal to confront them in front of the patient? Probably not, in most situations.

Not all scenes are going to be perfect. Sometimes someone's ego is going to be a little too big, and disrupt it all.

When you get to the hospital, you have a responsibility to pass information on to the staff. If someone else is passing on contradictory information, that's too bad. You can only give your version of events.

You have some responsibility to prevent other people from harassing your patient. But there's also a patient-provider relationship between the nurse and the patient. You can't kidnap them, but at the same time, if there's another healthcare provider there that's adamant this person should be transported, it's going to be hard to defend not transporting them if something goes pear-shaped.

 

[TLettuce]

glf?

Ground Level Fall. Sorry, assumed it was common terminology.

Home health needs to be paid. Otherwise they stop coming. Which is bad for the patient and will cause you to have to come more often.

Before flipping out about a nurse talking to another nurse and ignoring you, remember that like attacts like.

I don't disagree with you, but in this case my issues were that that:
1. Why are we being asked to halt the entire call just so the pt. can verify that home health did their job. Lets say we show up on a code or something of the sort, there is no way I am going to stop and sign as a witness for home health to prove they were there. There will be enough paperwork in the process to prove that they were there. I'm not concerning myself with their paperwork when I have a pt.

2. I would be perfectly fine with this as long as the nurse was not giving false and conflicting information, or blatantly interrupting my partner mid sentence. When we are the ones that are physically showing up with the pt. after being called by the pt. to their house. I think we should at least get a word in edgewise.

Outside of licensed medical facilities, and assuming that the HHA does not have some sort of legal recognition as a conservator or power of attorney, then they mean nothing in terms of being able to direct care. However, if the patient is competent, then the patient can choose to receive advice from whoever the patient wants. The sticky situation would be a competent patient and a HHA and EMS crew giving different advice. It may be the EMS crews "scene," but if the patient wants to take advice from the HHA I foresee issues if the crew decides to kick the HHA out because they don't like the advice being given.

These home health workers I don't believe have any medical training. Definitely no power of attorney over the pt. Some of them might be cna's at best but I doubt even that. In this particular situation they are only at the pt.'s house for a short while at a time to prepare meals. And that is pretty much it. The nurse shows up once every week or so for a short time as well.

Neither of us caused any conflict during this call. We did collect information from both the home health worker and the home health nurse. Pt was totally alert and oriented, although she was apprehensive about it, she did want to be taken into the hospital because of us. Home health wanted her to go in a long time ago but the pt. just wouldn't go. Transported because of general weakness.

I'm not sure what happened the pt. after we left.

 

[mycrofft]

Sound like you folks did good, despite the irritation.

As far as finding out the outcome, I'm surprised at how many calls posters here know the outcome of. We almost never knew, had to have someone on the staff willing to be a "source". (We found out we'd been exposed toy bloodborne TB one time by returning to the ER later and seeing biohazard tapes all over the triage/exam bay the pt was seen in).

HHA's CNA's etc. almost never have any standing UNLESS they happen to be next of kin.

 

[Veneficus]

I don't disagree with you, but in this case my issues were that that:
1. Why are we being asked to halt the entire call just so the pt. can verify that home health did their job. Lets say we show up on a code or something of the sort, there is no way I am going to stop and sign as a witness for home health to prove they were there. There will be enough paperwork in the process to prove that they were there. I'm not concerning myself with their paperwork when I have a pt.

Calm down, it was not a serious call. Home health didn't ask you to stop during a code. They asked you to help them meet their obligations on a patient that wasn't in emergent distress.

What makes you think your care is so important the paperwork can wait?

My care is not so important as to always leave the paperwork for later.

This was not an emergency. Even if she broke her hip, she could lay in the ED for hours, i have seen up to 6, waiting for ortho to have an available OR.

2. I would be perfectly fine with this as long as the nurse was not giving false and conflicting information, or blatantly interrupting my partner mid sentence. When we are the ones that are physically showing up with the pt. after being called by the pt. to their house. I think we should at least get a word in edgewise.

Was it conflicting because it was untrue, or because it was different than what you wanted to report?

When you are at this game a while, you will notice that patients tell different people different things.(for reasons I haven't bothered to figure out)

Have you considered these providers spend more time with this patient than you do and may just know something about her you don't?

These home health workers I don't believe have any medical training. Definitely no power of attorney over the pt. Some of them might be cna's at best but I doubt even that. In this particular situation they are only at the pt.'s house for a short while at a time to prepare meals. And that is pretty much it. The nurse shows up once every week or so for a short time as well.

Ummm. How much medical training do you have?

The RN is responsible for this patients long term care. She might not have to be present everyday, but I am willing to bet she knows more about this patient than you do. You may not know this yet, but often a long term provider has numerous insights that are beneficial to EMS providers. Sometimes it is just psych status or normal habits.

How would you feel if I dismissed your report because you have what I would call no medical education?

Neither of us caused any conflict during this call. We did collect information from both the home health worker and the home health nurse. Pt was totally alert and oriented, although she was apprehensive about it, she did want to be taken into the hospital because of us. Home health wanted her to go in a long time ago but the pt. just wouldn't go. Transported because of general weakness.

AKA in need of medical evaluation but not emergent.

I think over time you will discover you bring an extremely small part of the healthcare puzzle. Your skills are only valuable during an acute emergency, and even then only in "most" cases.

Just because somebody calls 911 doesn't mean they have an emergency. You had the opportunity on this call to learn something and be of benefit to the patient you were seeing.

It seems to me you were not focused on what the patient's issues were, you were playing "what if?" You did not seem to be much of a team player, and there exists the possibility that your information was erroneous or possibly just incomplete.

I wasn't there, so I am not going to speculate on what the patient's problem was or wasn't, but from your post here, it seems to me that you are just pissed off because you feel like you have some kind of understood authority and people were subordinating themselves.

Incidentally, how would you feel if you went to a hospital or other healthcare facility to transport a patient, needed paperwork signed and the staff thought they were too imprtant or too busy to take time out to deal with your issue?

and forgive me if I missed it, but what did you actually do for this patient?

 

[TLettuce]

I'm brand new to this forum and already I've upset somebody. :wub:

Calm down, it was not a serious call. Home health didn't ask you to stop during a code. They asked you to help them meet their obligations on a patient that wasn't in emergent distress.

What makes you think your care is so important the paperwork can wait?

My care is not so important as to always leave the paperwork for later.

This was not an emergency. Even if she broke her hip, she could lay in the ED for hours, i have seen up to 6, waiting for ortho to have an available OR.

The point I was trying to convey is that she was extremely rude about it, and acted as though her paperwork was priority over the patient...

We were called via 911 for general weakness in a slightly disoriented patient. Not sure about you but I can't diagnose in the field. So was it really "serious"? probably not... but when there's a possibility we don't tend to waste a whole lot of time. Especially within blocks of the hospital.

Was it conflicting because it was untrue, or because it was different than what you wanted to report?

When you are at this game a while, you will notice that patients tell different people different things.(for reasons I haven't bothered to figure out)

Have you considered these providers spend more time with this patient than you do and may just know something about her you don't?

Not sure if you read what I wrote... It was conflicting because it was untrue. Pt. claimed to have had a seizure that morning, RN claimed pt. didn't have a seizure. (RN was not at the house that day until the time of the call so she couldn't have known) We figured she could probably use the hospital visit to at least get her meds adjusted to help the patients recent seizure activity. Maybe you could understand why this would be a little frustrating?

Ummm. How much medical training do you have?

The RN is responsible for this patients long term care. She might not have to be present everyday, but I am willing to bet she knows more about this patient than you do. You may not know this yet, but often a long term provider has numerous insights that are beneficial to EMS providers. Sometimes it is just psych status or normal habits.

How would you feel if I dismissed your report because you have what I would call no medical education?

I nor my partner dismissed anybodies report. The health care nurse and the health care worker are two different people. The worker, from what I understand, does not have any training other than maybe first aid/cpr, their responsibility is simply to prepare meals. Also, we never got a report from the worker other than "she can't get out of her chair and I'm not strong enough to lift her"

The nurse DOES have plenty of medical training and hopefully knows a lot more about the patient than I do. But the fact of the matter is she was not at the house that day to attest to what events did or didn't take place.

AKA in need of medical evaluation but not emergent.

I think over time you will discover you bring an extremely small part of the healthcare puzzle. Your skills are only valuable during an acute emergency, and even then only in "most" cases.

Just because somebody calls 911 doesn't mean they have an emergency. You had the opportunity on this call to learn something and be of benefit to the patient you were seeing.

It seems to me you were not focused on what the patient's issues were, you were playing "what if?" You did not seem to be much of a team player, and there exists the possibility that your information was erroneous or possibly just incomplete.

I wasn't there, so I am not going to speculate on what the patient's problem was or wasn't, but from your post here, it seems to me that you are just pissed off because you feel like you have some kind of understood authority and people were subordinating themselves.

Incidentally, how would you feel if you went to a hospital or other healthcare facility to transport a patient, needed paperwork signed and the staff thought they were too imprtant or too busy to take time out to deal with your issue?

and forgive me if I missed it, but what did you actually do for this patient?

My skills are only valuable in an acute emergency? Really? I feel as though a lot of people on this forum would disagree...

What is it that makes you think we didn't gather the correct information anyways? I'm at a loss for a response to that one.

Wether I am on a call or not I don't appreciate people being rude to me and interrupting me when I'm busy. Besides like I said, there was no conflict the entire call. It seems like you have the idea that I acted out or something?

If I am transporting a patient and don't get the necessary paperwork the patient probably won't move until I get it. That worker has plenty of other means to prove that she was there, I don't need to sign her silly paper.

What we did for the patient... all I personally did was do vitals, convince her to go in to get looked at, get her in the ambulance and drive her to the hospital. The medic started an IV and that was it otherwise. But in the grand scheme of things we got her to go in get checked out and hopefully get her seizures a little more under control than they are now. We recognized an issue and started the process for further patient care. Which is our job a lot of the time.

If you don't mind my asking, do you even work 911? It doesn't sound like you know that much about the field.
_______________

I hope you understand originally... I wasn't taking shots at you. Clearly I offended you and hopefully you will get over it. No hard feelings brother.

 

[Shishkabob]

Since when does private property become "my emergency scene" in the EMS sense?

If 'the patient defines the emergency', I define the emergency scene. If they think it's an emergency to call 911, then that is an emergency scene, is it not?

 

[JPINFV]

My skills are only valuable in an acute emergency? Really? I feel as though a lot of people on this forum would disagree...

Ok, I'll bite. How much training and education do you have in non-acute, non-emergency care?

If you don't mind my asking, do you even work 911? It doesn't sound like you know that much about the field.

[popcorn.gif]

 

[TLettuce]

Ok, I'll bite. How much training and education do you have in non-acute, non-emergency care?

Where do you draw the line for non-acute, non-emergent? As an EMT are you useless unless someone is coding? I have no other formal training aside from my EMT.

 

[JPINFV]

Where do you draw the line for non-acute, non-emergent? As an EMT are you useless unless someone is coding? I have no other formal training aside from my EMT.

At the same time you aren't managing chronic hypertension. You aren't reducing and casting fractures. You aren't prescribing antibiotics. I could go on with the rest of medicine outside of emergency medicine.