ER Staff Attitudes

Alexakat

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I'm interested to know if others experience poor attitudes with their ER staff...& to what extent.

For example, when bringing in a patient, a nurse questions your treatment...("Why is he on 15 LPM? <that's our protocol>", "Why didn't you start an IV?" <I'm BLS>). How about when they do it in front of the crew, patient, family or other ED staff that may be standing around?

I've experienced this on many occasions...in addition to the dirty looks we get every time we wheel someone in to the ED---like they're saying "Why do you keep bringing us work!?!?!?!?" I'm sorry, but if a patient calls 911 & we respond & they want to go to the hospital, that's what we do <whether or not I personally feel as though they're probably OK, if they want to go, THEY GO!>.

I am not the most assertive person in the world & I'm still relatively new to EMS, so I have a hard time with this...

Any thoughts...or stories to share?
 
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firecoins

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I have gotten a bad attitude but never any unnecessary questioning. The ER nurses are very familiar with what BLS and ALS can and can't do. The only time I have been question is on calls that should have gone ALS but due to extraordinary conditions went BLS.

If you can get to know the nurses. Become friends with them.
 

Airwaygoddess

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Honey, Not that I am sticking up for people with VERY BAD MANNERS, but just remember that their are some really wonderful people in the E.R. You are the new kid so they have to figure you out and see if you have to do the same with them. And last but not least, there are two sides to the story, maybe they had a patient or patients with a very poor outcome , or even worse, the patient died. Even with all of the technology, state of the art, extra hands to help, etc. etc. sometimes it is that patients time to go. and that is a hard lump to take. Just hang in there, be patient. In this business we have to let things roll off our shoulders, but, no one is allowed to to act like a jerk, and be down right rude to you, that in my opinion can compromise patient care and looks very bad to the patient and family. If that is the case, that is when the chain of command comes in. I have been on both sides of the gurney, to sum it up, WE ALL GET BUSY! but it is our job to make it tolerable the best that we can! :) ^_^ :)
 
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Alexakat

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I totally understand your point AirwayGoddess. There are so many things that happen in a hospital day-to-day. EDs are stressful most of the time...I guess I see it from a different perspective b/c my "real job" is in another area hospital. I manage the medical staff services department & we deal with physician & allied health staff conduct (& correction of bad conduct when it occurs) all the time.

It's weird b/c on a daily basis I'm in such a different position than I am when I run rescue...I just really feel as though some of the nurses (SOME, I'm trying not to generalize, here) have an attitude of entitlement...& we're just lowly medics. They do it to the paramedics too...

I guess we all have bad days & aren't as chipper & wonderful as usual...but it seems to be a recurring issue at this particular ED.
 

Epi-do

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I think at some time or another we have all experienced something like that. We are all human, and we all have bad days. I try to chalk it up to that.

I do know when I was first starting out, I would get questions about why I did x,y, or z, but came to realize that alot of it had to do with my verbal reports durring transfer of care to the hospital. I didn't want to forget to tell them anything, and in the process would always forget something. The more reports I gave, the more consistant I became in how I would give the report, and the less often I would get questions about treatment. I also think part of it is your confidence level. The longer you do this, the more confident you will become, and people will pick up on that. When you come across as confident you have done the right thing for you patient, you will find people are alot less likely to question you about things.

A couple months ago, we were taking a lady to the ER who had called us because she was sick - general weakness, nausea, fatigue, low grade fever. She had a cardiac history, and about 2/3 of the way to the hospital she began complaining of radiating, crushing, sub-sternal chest pain, became very pale and diaphoretic. I followed our BLS protocol for chest pain at that point, and because I knew I could get to the hospital before I could get a medic, we continued in BLS. (We were only 2-3 minutes out.) Although for the particular hospital we were going to, a medic would not have needed to contact the ER, since we were BLS I did get them on the radio to let them know we were coming. There were no questions about why there was no monitor, IV, etc, and they were ready to immediately address the advanced care procedures the patient needed.

Things happen from time to time, and that BLS patient becomes ALS. When that happens, and I can't get a medic, I have gotten into the habit of always contacting the recieving hospital. Partly because I want them to be ready for me, and partly because even if I am BLS on a particular shift, my truck is stocked ALS and I can always get orders from a doc to administer nitro, albuterol, or a limited number of other medications that under our protocols I am not allowed to administer normally.

Like already suggested, your best bet may be to try to get to know the nurses at the particular facility you seem to be having problems with. After you have been in a few times and they recognize you, you will probably find that you aren't getting the questions that you are getting now. My guess is they are just trying to feel you out and get to know what your "style" is regarding how you treat your patients. Hang in there and I am sure it will get better!
 

Ridryder911

EMS Guru
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Okay, here is the other side of the coin.

First, I cannot remember which service is BLS/ILS/ALS/CCP etc... I may see between 5 to 10 services a day. I don't have time to read or decipher your acronyms on your badge, patches.. even then, you may not be allowed to do a procedure.

Remember, this is an additional patient, not the only patient I have to take care of. Usually I will have 4 to 5 others, ranging from chest pain to dental carries. Of course family being pissed off because the physician has made them wait a whole 30 minutes. As well as physician writing or yelling orders (about 10 of them) in what to do on the patient, that you brought in and the patient has not even admitted into the computer yet.

I question you because :

1. It is my patient, I need to know as much as possible.

2. There is charting that requires whom, what level of care PTA, IV where at, how much infused, how much is left, any s/s of infiltration, patency.. This is just a triage sheet.

3. The Doc will ask me again, after you leave...

So don't be discouraged. The same questions should be asked if you are transferring from hospital to hospital.

Like Aiwaygoddess described, it is the usual way. I doubt they realize they are rude, actually they are just trying to deal with they have to work with. While you are able to clean up your unit and take a break.. they now have another additional patient to deal with for probably at least 4 to 6 hours.

To be in EMS you need to learn to be like a duck and let most of the stuff roll of your back... try to take nothing to personal....


Good luck,
R/r 911
 

Stevo

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the nurses union here trashed our paramedic intercept , which was staged at the hospital for about a year (after many years in the making)

i have no sympathy for any of them

you want a 'tude? give me a jingle after a call where the patient direly needed als, and couldn't get it



~S~
 

KEVD18

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there a difference between being busy and multi tasking; and being a :censored::censored::censored::censored::censored: because i brought you a pt. i have walked into an empty, not 1 or 2 pts, but empty with a minor call and been given the tude. well, it goes both ways. the major boston hospitals dont require low priority entry notification so if im not coming in with a code or trauma alert, or if i dont need a special team stnading by, i just roll in unannounced. give me attitude early in the night, you get every drunk, every "sick dont feel good", basically every nothing call i can take there. its a two way street....
 

Guardian

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I'm not here to trash nurses because I admire the job they do. I will say that some do have attitude problems. Many seem to think it's ok to treat us like crap when the ED is busy. Guess what, if you don't like an overly crowded ED then either try and change the policy or go work in a doctors office, but don't treat us like crap. Just remember, don't give in to the temptation to treat them like crap right back. We must be professional no matter what and if you treat them badly, then it makes all of us look bad.

After a while, I stopped caring what nurses thought of me. This is probably the biggest insult I've ever given nurses, but it's the truth. I'm an expert in prehospital care, so what do I care what a nurse thinks of me. They have very little if any prehospital medical training. Go up and ask an ED nurse when the last time he/she ran a code or intubated someone and see what they say.
 

FF/EMT Sam

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The nurses tend to be even more worn out and overworked than we are. Treat them nicely, and they'll treat you OK, too.
 
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Alexakat

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I'm not here to trash nurses because I admire the job they do. I will say that some do have attitude problems. Many seem to think it's ok to treat us like crap when the ED is busy. Guess what, if you don't like an overly crowded ED then either try and change the policy or go work in a doctors office, but don't treat us like crap. Just remember, don't give in to the temptation to treat them like crap right back. We must be professional no matter what and if you treat them badly, then it makes all of us look bad.

After a while, I stopped caring what nurses thought of me. This is probably the biggest insult I've ever given nurses, but it's the truth. I'm an expert in prehospital care, so what do I care what a nurse thinks of me. They have very little if any prehospital medical training. Go up and ask an ED nurse when the last time he/she ran a code or intubated someone and see what they say.

I'm always my nice, sweet, professional self to the nurses or any other patient, family member, crew member or individual I come in contact with...on or off duty. Even in the face of being raked over the coals, I remain calm, cool & collected, knowing I did my best. I feel comfortable with my patient care & my COR reports & if someone feels the need to point out something that wasn't to their satisfaction, I just listen & remain positive, hoping to learn something from the experience. I know that when someone has a comment about whether someone was on 6 vs. 4 LPM & they make a point to say it in front of the patient & everyone standing around me, there's something else going on there...seriously, I admire nurses too. They have hard, thankless jobs most of the time.

I like what Guardian pointed out & will remember this the next time things get tense in the ED...they have very little prehospital medical training & most likely do not understand the rigors of being "on the streets" & what we deal with, just like we don't quite understand the challenges of working in a busy ER. It's all about perspective!

Thanks for your input!
 

jeepmedic

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You will find out that most of the nurses that treat you nice are the ones with an EMS back ground or have worked mostly in the ED.

But like Guardian said Don't give in and give them the same treatment back.
 

firecoins

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It is true the ones most familiar with EMS are the nicest to EMS. Same with the doctors, cops and firefighters.
 

jmac2601

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As one who has worked both sides of the cot, (And now desk, medic to nurse to ems managegment.) I've taken the kill 'em with kindness approach. All my staff are trained when off-loading the patient to explain that X hospital and their professional nursing staff will take good care of them. This is my professional obligation to the emotional needs of the patient. I just overlook most of the crap. Life's to short and the patient has too many needs to become reactionary by the insecurities of someone having a bad day.
Sure it ranckles my nerves to have Nurse Rachet shove their associates degree down my throat and cut my report off before the patients last name is out. (Or put the shoe on the other foot when I wore scubs and white shoes for a living: the rare arrogant alpha male/dominate female in-your-face-because-a-nurse-never-intubated-a-drunk-in-ditch-at-0300!!! Patient report. Oh, yes. We EMS folks can be just as cranky as Mr. or Mrs. higly paid nurse <_< )
Stay safe all,
Southern MO Medic, rn. . .
 

firecoins

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I guess I am lucky enough when I finish the medic program that I too will have an associates degree in paramedicine.
 

BossyCow

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Boy I just can't say it enough.... There are :censored: :censored: in every line of work. The key is to minimize the impact of someone else's power trip on your attitude and your patient care. The ER is filled with .... and try not to be shocked here..... PEOPLE. They have bad days, some have bad years and there's the same assortment on both sides of every fence. When people are stressed for reasons associated with their jobs or their lives outside of work, the social skills sometimes turn up missing.

I've found the best way to deal with it is to give that nurse, medic, doc, cop, family member, superior, who gave me a bad time, the biggest happiest "Hello glad to see ya" the next time I see them. Maintaining a good mad takes way more energy than I ever want to waste on something that stupid.
 

fm_emt

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I'm usually friendly and try to give as much information as I can to the ER staff. It's been a while since I've run into a nurse that made me mad.

*knocks on wood*

It's the clueless 'assisted living' folks that make my blood boil sometimes.
 

firecoins

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It's the clueless 'assisted living' folks that make my blood boil sometimes.

Non ER nurses were far worse in my experience. Not because if attitudes but because of stupidity.
 

fm_emt

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Non ER nurses were far worse in my experience. Not because if attitudes but because of stupidity.

Oh yeah. I've encountered a few that were at the bottom of the heap. Ugh.

Then again, last weekend we rolled up to a private residence and there was a home care nurse there. She recognized that something was wrong with the client and called us. When we got there, she had just taken a set of vitals and gave us an excellent report.

So, it's kind of hit & miss.
 

Ridryder911

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Just to think I hear about the same for EMT's not even knowing what gram stain bacteria (basic science) is or what a J-peg drainage is. So, like someone described every profession has it's bad and good...

Especially those that develop an attitude and having nothing to back it up..

I have seen it on all sides.. it is much better to be assumed to be a fool, than remove all doubt.



R/r 911
 
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