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My service does provide this service to our contracted facilities. Not everyone takes us up on this offer though.
Sent from my out of area communications device.
EMS vs Nurses
- Thread starter ParamedicLuvnNurse
- Start date
My service does provide this service to our contracted facilities. Not everyone takes us up on this offer though.
Sent from my out of area communications device.
mycrofft
Still crazy but elsewhere
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Are we telling the emperor his clothes are absent today?
Many EMT's come on as cowboys, many nurses come off as being nursing supremacists, the majority are just busy doing their job and you never remember them.
Nursing as a culture tends to be very interested in finding fault and avoiding blame, sort of a circular firing squad deal.
EMT's doing IFT are often disillusioned or bored.
THis makes for a bad interface.
Don't get me into the cross-cultural nursing subject. Many excellent nurses there, but the issues of language barriers and the difference in cultural expectations regarding gender, nursing autonomy and medical excellence...just don't.:wacko:
Many EMT's come on as cowboys, many nurses come off as being nursing supremacists, the majority are just busy doing their job and you never remember them.
Nursing as a culture tends to be very interested in finding fault and avoiding blame, sort of a circular firing squad deal.
EMT's doing IFT are often disillusioned or bored.
THis makes for a bad interface.
Don't get me into the cross-cultural nursing subject. Many excellent nurses there, but the issues of language barriers and the difference in cultural expectations regarding gender, nursing autonomy and medical excellence...just don't.:wacko:
I agree completely.
It's ok for them to not know every patient's complicated history inside or out. And it's ok for them to be stressed about emergency care, and relieved when we come. No problem. I recognise it's sometimes difficult to appreciate the severity of the patient's condition when you lack acute care experience.
But then you have these situations where the patient has a perfect set of vital signs five minutes ago, the nurse is saying "he was complaining of feeling a little short of breath", and the patient is pre-code, completely septic and ARDS looking, or they're about to get intubated without sedation, or they're profoundly hypoxic / hypotensive. Or maybe even rigored. But the documentation and report don't reflect the change in the situation. I recognise that situations change, I do, and I've been caught out when I arrive at the hospital to find somethings changed, but when this happens a lot, it makes me a little skeptical.
Not being an ER / ICU is fine. Not accurately representing the patient's conditon, not so much.
Amen. I couldn't either. And if I wanted to learn, I think I'd go to nursing school. I wouldn't want to switch roles.
Shishkabob
Forum Chief
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Which part?
I guess what irritates me the most is when other providers (nurse, mid-level, physician, RT, take your pick) feel that they know more than me about my scope of practice, my training and education, and what I should be doing. Every field has their stellar providers, their miserable people, and their incompetent window lickers. Nursing and EMS are no different.
One of the hospitals I am currently working out of has several RN/paramedics in the ED, and a group of EM physicians that are very EMS knowledgable. For those, I'm pretty lucky to be working there. A large group of midlevels, esp the NPs, however, are CLUELESS about what a paramedic knows or can do, even at the most basic level. The don't understand at all the tiers of BLS, ALS and critical care for interfacility transfer, and quite a few have no desire to learn. This is the attitude the bugs the crap out of me. Every provider has their strong and weak points, and their areas of knowledge where they excel. Telling me how to do my job (and being wildly wrong) while refusing to have a conversation where I try to politely educate you about what I do means that I have minimal, if any, respect for you.
I think one of the reasons that nurses get blasted by EMS so often is that we simply interface with them more than any other medical provider.
One of the hospitals I am currently working out of has several RN/paramedics in the ED, and a group of EM physicians that are very EMS knowledgable. For those, I'm pretty lucky to be working there. A large group of midlevels, esp the NPs, however, are CLUELESS about what a paramedic knows or can do, even at the most basic level. The don't understand at all the tiers of BLS, ALS and critical care for interfacility transfer, and quite a few have no desire to learn. This is the attitude the bugs the crap out of me. Every provider has their strong and weak points, and their areas of knowledge where they excel. Telling me how to do my job (and being wildly wrong) while refusing to have a conversation where I try to politely educate you about what I do means that I have minimal, if any, respect for you.
I think one of the reasons that nurses get blasted by EMS so often is that we simply interface with them more than any other medical provider.
Pneumothorax
Forum Lieutenant
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Not many people realize this!
Being an EMT in the field, and ER tech in the hospital & working in the capacity as an RN (still in school:/) I see both sides of the coin & it really disgusts me to see how RNs treat EMS as I've experienced it first hand. I never want to be like that and hope I won't be. Some days I wish I had my RN license so I could say --- hay! Get off your high horse, I'm just as smart as you are so stop talking to me like I'm an idiot and grow up!
Oh, & ppl who are nurses aren't the ones who couldn't hack it thru med school whoever said it. Maybe they didn't want to be a doc!
ParamedicLuvnNurse
Forum Ride Along
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sw ftw
Bullets
Forum Knucklehead
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My issue is perceived lack of care. The METHODIST HOME SNF in my area is great, hand you complete copies of records when you walk in, nurse supervisor gives a detailed report, and the PCAs assist us in anything we need. They are a fantastic group.
But the other SNF in my town gets the attitude. Calls 911 for unresponsive/CPR we arrive to find pt sleeping, or ice cold and livid, but was normal "10 minutes ago, or complaining of chest pain for 3-4 hrs and when nurses do this at 2am, believe they are getting an attitude
But the other SNF in my town gets the attitude. Calls 911 for unresponsive/CPR we arrive to find pt sleeping, or ice cold and livid, but was normal "10 minutes ago, or complaining of chest pain for 3-4 hrs and when nurses do this at 2am, believe they are getting an attitude
I couldn't help but notice a lot of complaints here about not getting a printed history or a concise report.
I must ask the people complaining:
Do you not perform your own history and physical absent the bias of another provider?
Do you have trouble correlating your findings?
I must ask the people complaining:
Do you not perform your own history and physical absent the bias of another provider?
Do you have trouble correlating your findings?
Every patient gets a physical exam and history by me, however, around 75% of the patients I'm dealing with are too demented/intubated to give a good history. Which again, is not a huge problem...until I don't have anything other than a transfer report. At that point it gets a little tough to explain to the ED staff why I have nothing other than physical exam findings on this patient (and that includes the junior and senior who flipped out the other day because I wasn't fast enough with the paperwork apparently
).
NomadicMedic
I know a guy who knows a guy.
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+1. A 911 call to a SNF is what it is. And if I don't get any paperwork, oh well. However, when I was doing IFT, I wanted a full packet and I'd wait until I got one.
RocketMedic
Californian, Lost in Texas
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Money matters too. Many SNFs and such dont fund adequately, or the staff doesnt keep up or care. When I see a patient with an houes or days old diaper or who is suffering due to neligence, and the nurses are the ones responsible, that breeds resentment and dislike.
Every patient gets a physical exam and history by me, however, around 75% of the patients I'm dealing with are too demented/intubated to give a good history. Which again, is not a huge problem...until I don't have anything other than a transfer report. At that point it gets a little tough to explain to the ED staff why I have nothing other than physical exam findings on this patient (and that includes the junior and senior who flipped out the other day because I wasn't fast enough with the paperwork apparently
Why would the ED get upset all you had was a physical exam?
If you brought in an unconscious patient found in the street, you would only have a physical exam.
Is there really a difference between an unreliable history and no history on any patient population?
Sounds to me like the ED was just pissed they had to actually do some work.
Yes, I think there is.
These patients are coming from a facility with medically trained staff. Some nurse, somewhere, called a doctor to get permission to send the patient out. These are licensed providers who are being paid, often quite well, to provide care to people who can't do it themselves.
I'm OK with overworked staff doing the best they can. I'm OK with staff that is in over their heads, clinically and knowledge wise. I'm NOT OK with staff that doesn't do a decent baseline assessment, doesn't have paperwork with AT LEAST demographics, history, meds and allergies, and isn't willing to give a report of what they've found and why they've called. Not only is it common courtesy to pass along all of this information in an organized manner from one provider to another, it's accepted as good baseline medical care, and important to the patient's well being and ability to get good care where they go.
I haven't even touched on the attitude of not regarding me as a professional, or looking at me as an ambulance driver, or something they just peeled off the bottom of their shoe because I'm not a nurse.
JPINFV
Gadfly
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How often are SNF patients normal at baseline and competent historians both in terms of HPI and past medical history?
JPINFV
Gadfly
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Having no history because no competent historian is available is unfortunate, but unavoidable.
Having no history when a competent historian is available is poor patient care from at least one, if not both, sides of the equation.
Does it matter?
JPINFV
Gadfly
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If your patient has a level of consciousness less than A/Ox4, then yes, knowing that the patient has dementia or Alzheimers, or any sort of other non-acute disease processes that changes the patient's neurological status is rather important.
If the patient is status post CVA with persistent deficits, that becomes important to know both the fact the patient has a CVA and what the deficits are.
Edit: Alternatively, do we treat every patient as having no history, thus rerouting and upgrading for clinical signs that in reality have no acute significance?
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Will it change the workup any in the ED?
How about for EMS?
Are people with prior deficits not checked for new onset pathology?
The point I am trying to make is that this nursing home thing has been going on for at least decades, and rather than complain an moan about it, simply take steps to move on.
We can argue the importance of it forever, but in terms of the acute event, whatever it was called in as, a full assessment will have to be done again.
Exams are repeated by each provider for a purpose.
Do you always trust the report or exam of another provider, particularly one of lesser training or one you have never met?
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When my patient from a SNF actually can tell me their HPI and their PMHx, I obtain their version of it. When they can't, I can't. I have to go by what I see and what's in the transfer packet, if there is one. Also, since the patient is coming from another medical facility, the ED expects that there will be some kind of packet showing the patient's known medical history, what meds the patient is currently on, and so on... Do you think you could remember all 15 meds you're on when you think Eisenhower is President?