For instance I had a potentially unstable patient-- my gut told me something was wrong, and the patient had an altered LOC at baseline so for me there were too many "what if's"-- so I told my partner to proceed Priority to the hospital, and this person refused. It added a minute or two to my transport which in the end wasn't the end of the world, but the fact of the matter is, as the ALS provider its my call.
This is a bad example and reflects poorly on your competence and your ability to make judgement calls. First, either the patient is stable or he isn't..."potentially unstable" is malarkey. Everyone is potentially unstable. Your gut told you something...hoorah! What did your clinical assessment tell you? What did your vitals, your reassessment and review of medical history and comorbidities tell you? What interventions did you need to perform on this potentially unstable patient? There are a lot of "what ifs" on every single patient we touch.
Personally, I think you need a lot more education and experience in your newly acquired PIC role and maybe should focus on that before you start trying to bone up the leadership position and attitude based on that title? Make sense? You are in command now, you want to lead now, yet you display no competence (possibly) in your skills and education. That right there will cause people to give you zero respect and zero credibility.
So please, tell us what the follow up on the patient was? Also, you need to keep this in mind...you were not up front driving. Maybe your partner realized the situation was NOT safe to proceed as you were dictating. Maybe he/she was NOT comfortable driving faster? There are a lot of maybes with why they chose not to drive faster and you need to give consideration to that. Sure, they could have communicated that, however that was not the time as you had a potentially unstable patient and they were dealing with whatever reasons they had for not following your order.
Are you personally aware that expedited times have shown no benefit to the patient and have significantly increased risk to the providers (YOU and your partner) and the general public? There are a lot of studies, you should review them and learn. That 1-2 minutes "saved" would have ZERO benefit and 100% more risk...is it worth it?
I would challenge you on this "as an ALS provider it is my call"...I would posit that it is BOTH of you guy's call on whether or not to increase speed and risk. It would also go a long ways to increasing communication and garnering respect.
Example: Hey Joe, I do not feel good about this patient, is it safe for you to go lights and siren the rest of the way?
If yes, then proceed.
If no, call for intercept.
If no intercept, then monitor the basics and treat accordingly.
I'm not a hard-on for this job, frankly my usual attitude is "DILIGAF" except when it comes to those under my care.
Piss poor attitude. If your usual attitude is "Do I look like I give a Fkcu" then you sir are a problem. If you want to be a better leader, then practice it and actually give a F*. A good leader is someone who is always leading, not just on the calls. They are leading in and around the station when there is no adrenaline infused excitement. They are the ones who double check equipment, clean equipment/rig, clean station, check paperwork and in general have a nice attitude, not one that makes you question if they give a F or not.
I would have zero respect for you myself as well, if you have this attitude and only try to flex authority when you think it is warranted. You sound misguided right now with regards on when and how to lead. Lead by example. Do not give directions on something you yourself would not do...and jump in and do it yourself.
Example: When I visit some of my facilities, everyone is on top of it. Inevitably I always find something but instead of being an ***, I start fixing whatever it is. Sure, that only lasts about 30 seconds, but I never have to say a word. They know, they remove the rag from my hand or pick up whatever I started and then they get it done. Lesson achieved without saying a word or feelings getting hurt.
I'm friendly and the way I look at it, we're a crew/a team... but at the same time if my directions are being ignored by the lower level provider, then corrective measures are needed-- while the write up route is there, I'd much rather handle it in a "team huddle" that way nobody catches flak from management.
You say you are a team however I did not get that from all the paragraphs above this one. You need to be PROACTIVE and not REACTIVE which is where you are right now. Fix yourself for starters. Then have a chat as I said earlier. Lay out the expectations when there is nothing else going on. Then when something does happen, you both know where each other stands.
What you need to do is have a sit down and bring up the situation. Say, "Hey the other day when I asked you to go lights and sirens and you chose not to, I was really perplexed why you chose not to...was there anything going on I was not aware of?" Then shut up....you posed a problem, you made the problem potentially about you and now you let the person speak. No defensive attitude, no interruptions, let their words flow. You might be surprised what you hear. After they are done, then you calmly need to say..."Look, in the future we need to communicate better. I do have the expectation that when I request a speedier drive that you will do it. I am asking because I am uncomfortable or something bad is going down. If there is any reason why you think we should not go faster, I need you to tell me right there so I can then go to Plan B".
Any ideas how to be an effective "PIC" so that my truck runs smoothly and I can ensure the best care to my patients?
Yes...read everything I wrote and then read it again.
