EMS vs Nurses

[ParamedicLuvnNurse]

If you can't tell by the name already I'm a Paramedic loving Nurse. That's right, my husband is a Paramedic and I fully support him in his career and admire him for the work he does.

I work in Long-term Care. It's not what I want, but it's where I am at until I finish up my degree and move forward to somewhere more desirable.

I guess this thread is mainly to give all of you support and let you know that not all nurse's are trying to dump their resident's off on you for minor issues. My husband has been frustrated so many times for this very reason and all I can do is sympathize.

I try my best to keep my residents in the building for the following reasons:

#1 I hate the paperwork that comes with it, and there is a ton of it!
#2 I can put ice on a bump or bruise and call X-ray out for an exam. I can utilize my knowledge, resources, nursing interventions and such. This makes me feel stronger and smarter, thus why I do it.
#3 I'm all about keeping down cost towards Medicare and Medicaid!!

I have been given the cold shoulder so many times by EMS crews when they enter our facility to pick up a resident. When our MD's give us an order to send someone out even as minor and ridiculous as it sounds to us, we do it. Deviating from a MD's order (FYI, every resident that leaves a facility gets this order unless it's a dire emergency and we send out first, then contact MD) would cost us not only our jobs, but our licenses. Not seeing that a resident receives the treatment that is ordered is considered abuse and neglect, the same for you all I'm sure. Sending someone out with an obvious minor injury without consulting the MD will also have a nurse in trouble with the state.

I personally appreciate you all because you ARE important to the nurse's that care and the one's who want to see healthcare make changes for the better.

Smile when you see a nurse even if she doesn't smile back. It could mean the world to her/him that day because nursing is rough and you have to be tough as nails to survive it. We lose ourselves each day in protecting ourselves from other nurse's and keeping our jobs secure. Nursing is very ruthless and cut throat, so that is where the negative attitudes are coming from that you all see. I have spoken to my fellow nurse's about this and the attitudes have nothing to do with EMS crews, but they unfortunately take a beating from whatever the nurse is going through internally at that moment. For that, I am sorry for whoever has experienced such.

It's definitely not roses. I think I am severely underpaid. Many days I wish there was something mindless I could do to earn a living like - basket weaving!

 

[Handsome Robb]

I think a main thing that causes friction between nurses and paramedics beyond patient care is that many nurses look down at paramedics, somewhat to the view of "you couldn't hack it in nursing school so your a medic" type of thing. Yes our education is substandard with the select few medic programs going above and beyond, but when you look at it we have similar education when it comes to emergent problems. In fact the education of a paramedic may exceed that of a nurse in true emergent situations.

I applaud you for your recognition of the problem and your efforts to be friendly towards EMS crews. The issue in my experience is nurses, either LPNs or RNs detachment when we are around. It always seems to be "The doctor ordered the transfer, get out of here with the patient" type of attitude in my experiences. I do agree that EMS crews need to be more friendly towards facility staff as well, it's a two-way street.

I'll put a disclaimer on my post: I work 911 but there is no IFT company here, we do all IFTs, although the only thing that really gets transferred from hospital to hospital is traumas, all SNF calls come in as 911 calls.

 

[RocketMedic]

Many times, we as EMS run into nurses who give incomplete, wrong, or downright negligent treatment and reports. I've watched an ER nurse transfer a CHFer out on 2l via NRB "because it's like a cannula if he's a mouthbreather". I've watched a nurse in the same facility (William Beaumont AMC) literally ignore a man in his late 80s having an MI and getting paler, and another one take nearly thirty minutes to even call for CPAP for a man who really, really needed it. I've seen nurses who literally don't know how to give D50 or Glucagon.

I know there's great nurses, but you can see it from our side- we often make less than you, and we often see nurses at their worst...so you can see where we complain from.

 

[RocketMedic]

I think a main thing that causes friction between nurses and paramedics beyond patient care is that many nurses look down at paramedics, somewhat to the view of "you couldn't hack it in nursing school so your a medic" type of thing. Yes our education is substandard with the select few medic programs going above and beyond, but when you look at it we have similar education when it comes to emergent problems. In fact the education of a paramedic may exceed that of a nurse in true emergent situations.

I applaud you for your recognition of the problem and your efforts to be friendly towards EMS crews. The issue in my experience is nurses, either LPNs or RNs detachment when we are around. It always seems to be "The doctor ordered the transfer, get out of here with the patient" type of attitude in my experiences. I do agree that EMS crews need to be more friendly towards facility staff as well, it's a two-way street.

I'll put a disclaimer on my post: I work 911 but there is no IFT company here, we do all IFTs, although the only thing that really gets transferred from hospital to hospital is traumas, all SNF calls come in as 911 calls.

This. So this. Way, way too many nurses look at us like quasi-skilled labor. It breeds hostility between us when one party thinks of us as too dumb to be in their shoes. To that, I say that EMS is probably more difficult in terms of true emergent situations.

 

[Shishkabob]

This type of thing gets beat to death, so I'll say one thing:


My favorite nurse? The nurse who is also a Paramedic. I've yet to meet one that wasn't good at their job, whilest I've my fair share of nurses AND medics who are retarded beyond belief.

 

[abckidsmom]

This type of thing gets beat to death, so I'll say one thing:


My favorite nurse? The nurse who is also a Paramedic. I've yet to meet one that wasn't good at their job, whilest I've my fair share of nurses AND medics who are retarded beyond belief.

I agree. Nurse/paramedics are a rare breed.

 

[Handsome Robb]

This. So this. Way, way too many nurses look at us like quasi-skilled labor. It breeds hostility between us when one party thinks of us as too dumb to be in their shoes. To that, I say that EMS is probably more difficult in terms of true emergent situations.

I'll play devil's advocate and say that long term care is more difficult than emergent care. We fix life threats and save lives occasionally however nurses deal with the trainwrecks we bring them from days, weeks or even months. I have a ton of respect for nurses but I don't take kindly to be disrespected by them or anyone else.

As for negligent care it happens prehospital, inhospital and in long term care homes. It shouldn't but it does happen. A coworker of mine ran on a "cardiac arrest CPR in progress" not too long ago. They show up to find an 88 yo female postictal enduring CPR. They were called to the same SNF 2 weeks later for a different patient, stopped to check on the 88 yo. She had circumferential bruising along with multiple broken ribs and was now bedridden due to her injuries sustained during the CPR that wasn't indicated....

 

[JPINFV]

I think a main thing that causes friction between nurses and paramedics beyond patient care is that many nurses look down at paramedics, somewhat to the view of "you couldn't hack it in nursing school so your a medic" type of thing.

Meh, just remind those nurses that they're only nurses because they couldn't hack it in medical school.

 

[Shishkabob]

Meh, just remind those nurses that they're only nurses because they couldn't hack it in medical school.

My medical director is a Paramedic, RN and DO. Worked as all 3 too, in that order. Keeps up his certs and runs calls out in the field with crews consistently. He has a habit of asking the Paramedic for 5 differentials during a call


:unsure:

 

[Handsome Robb]

My medical director is a Paramedic, RN and DO. Worked as all 3 too, in that order. Keeps up his certs and runs calls out in the field with crews consistently. He has a habit of asking the Paramedic for 5 differentials during a call


:unsure:

Now that's awesome. My friend's sister has been a CICU nurse for 6 years. She admits that when she rides with her brother she is completely lost on a scene. While we all practice medicine, we all practice very different forms of medicine. All that matters is that someone recognizes when they are out of their element.

 

[STXmedic]

My medical director is a Paramedic, RN and DO. Worked as all 3 too, in that order. Keeps up his certs and runs calls out in the field with crews consistently. He has a habit of asking the Paramedic for 5 differentials during a call


:unsure:

Your medical director is awesome. I've met him a couple times; he always treats you with respect and without the superiority complex. Sat in on a sepsis speech from him a few months back that was awesome.

 

[FourLoko]

Going to post then come back and read.

I'd be happy if we actually had doctors asking for patients to be taken to the hospital. What usually happens is we come to pick up patients for dialysis who are routinely neglected by both nurse and respiratory therapist staff.

For example the patient we encountered with a BP of 190/100 when we show up. "Oh she got her meds" says the nurse. PT also in pain. Nurse proceeds to try and pump some new meds via Gtube. Doesn't work, Gtube is not working properly.

Should have been noted in the morning. Didn't take an RN or MD to realize the meds for BP and pain weren't being administered properly. We had to wait nearly 2 hours before we were finally able to get the paperwork to take this patient to the ER instead of dialysis.

 

[DrParasite]

Many times, we as EMS run into nurses who give incomplete, wrong, or downright negligent treatment and reports. I've watched an ER nurse transfer a CHFer out on 2l via NRB "because it's like a cannula if he's a mouthbreather". I've watched a nurse in the same facility (William Beaumont AMC) literally ignore a man in his late 80s having an MI and getting paler, and another one take nearly thirty minutes to even call for CPAP for a man who really, really needed it. I've seen nurses who literally don't know how to give D50 or Glucagon.

To be honest, that annoys me, because it is detrimental to the patient. Or the cold and dead patient in the SNF who "was fine 10 minutes ago when I checked on them." Yeah they ice up and have rigor start in that 10 minutes.

What annoys me to no end is when a facility calls 911, and then isn't ready for EMS when we arrive. That means the chart isn't copied, no interventions have been done, the transfer form is all filled out or the nurse is no where to be found to give EMS a report of what is happening. it takes between 4 and 11 minutes for EMS to arrive to a life threatening emergency (from the time the 911 call is made), and most of the time, EMS is going to be in and out in less than 30 minutes.

If the nurse has the chart copied, the transfer sheet filled out, has done SOMETHING for the patient, and greets EMS at the patient's door with a report on the situation and what they have done and then steps back and lets EMS do their thing (but sticks around in case we have any questions), I am happy. Even if they don't do the right thing, at least it gives me the information to do my job properly.

I understand that almost everything a SNF nurse does is at the doctor's order (running joke is a nurse can't fart unless a doctor says she can), and they get in trouble for deviating. Personally, requesting an IFT truck from who knows where for a chest pain or seizure patient, and a 911 truck for a patient with a fever for 2 days annoys me, but I know often the doctor makes the call not the nurse.

We all have our rules and our protocols, and sometimes they suck and handcuff you more than you want, but if you (the nurse) calls me, be ready for me so I can do my job. don't hold me up because you haven't made the 911 emergency your priority, especially when you have given me a sick patient.

 

[rmabrey]

Ive had my fair share of Nurses that look down on us and tell us we arent allowed to do things (look at the Pt's records, start Iv's, give meds).

Usually these are the same RN's that are Trying to bring a patient out of a seizure by running a VNS magnet over port access :rofl:, or wonder why a patient is unresponsive when they basically OD'd them.


But for the most part the nurses treat us with respect, and we do the same (even to the problem nurses, cause they will complain on us)

 

[usalsfyre]

Beating up on LTC nurses is the national EMS pastime. Much of it stems from misunderstanding. Much of it also stems from the godawful care and excuses for said care that is all too common in these facilities (it's 2am, there's no way in hell you just got here, I saw you yesterday so you weren't on vacation and your one of two nurses in the facility tonight so it's probably your patient).

That said....among the paramedics in here, who thinks they could handle a 50:1 ratio, while supervising the equivalent of multiple EMT-Bs and having to ring up med control (who's off duty) everytime something unforeseen happens? Because I couldn't, and that's commonly what RNs and LVNs in LTC are facing.

 

[JPINFV]

My medical director is a Paramedic, RN and DO. Worked as all 3 too, in that order. Keeps up his certs and runs calls out in the field with crews consistently. He has a habit of asking the Paramedic for 5 differentials during a call


:unsure:

I'd love to be a fly on the wall the next time a RN question's that paramedic's treatment decisions rudely.

[youtube]LqeC3BPYTmE[/youtube]

 

[Handsome Robb]

I'd love to be a fly on the wall the next time a RN question's that paramedic's treatment decisions rudely.

"What do you think your a doctor or something!?"
"Actually, I am a doctor, and a RN, and a Paramedic..."
cue awkward silence...

Haha

 

[JPINFV]

"What do you think your a doctor or something!?"
"Actually, I am a doctor, and a RN, and a Paramedic..."
cue awkward silence...

Haha

RN mad about the patient getting more than 3 doses of nitro: "...and where did you go to medical school?"

Paramedic in a deadpan voice: "Harvard."

 

[Akulahawk]

Something that definitely chaps my hide about LTC nurses in general is that many times we'd get called out for something like "weakness and lethargy" or "failure to thrive" and when we get there, the patient is obviously in shock or is obviously having an MI or is obviously having CVA symptoms and 911 wasn't called because the vitals that were taken 2 hours ago were "stable."

While I definitely respect the fact that LTC nurses are very heavily burdened, my impression of many of them as being barely competent stems directly from the above experiences... and I've had more than enough similar experiences with different nurses at different LTC facilities to have come to that conclusion.

Any "transfer" out to the ED, I'm going to discard the chief complaint given to dispatch and relayed on because inevitably it is going to be so wrong... I will listen to report (if I can find the patient's nurse) and probably discard most of it unless it actually makes sense based on what I find.

I really don't mind if the nurse tells me that the doc ordered the transport for whatever reason or that the patient has been having whatever symptoms for however long and the ALOC is different from normal and tells me how so...

Take two minutes out of your day to tell me what's going with the patient. Have the transfer paperwork ready, or at least a face sheet, copy of the MAR, and the patient's history along with a quick report as to why I'm taking the patient to the ED. And don't misrepresent the patient's status to me, especially if you tell me that the patient is fine, vitals are stable, and what I see is a patient who is circling the drain and clearly getting ready for celestial discharge... Yeah, I've had those patients more than once...

 

[Handsome Robb]

RN mad about the patient getting more than 3 doses of nitro: "...and where did you go to medical school?"

Paramedic in a deadpan voice: "Harvard."

Meh situational dependent, we aren't limited to 3 although at that point IV infusion would be better IMO but as long as their BP will handle it we can keep on giving it. Usually if we are far enough out to need more than 3 SL doses they will get NTG paste. It's better than 400 mcg slam then nada then 400 mcf slam then...you see what I'm gettin' at.