Nurses eat their young.

[rescuepoppy]

I have found that one of the reasons for the way some nurses treat students is that they become protective of the patients in their care. They have in too many cases had students either nursing or medic students come into their unit with the attitude of "that is not the way this is done,we do it this way". You have to remember these are the people who have been doing this for a lot longer than the student has.

Recently I was doing clinical time in or local hospital,I had the fortune to do all of my time with a nurse who had not too long ago came there from another hospital she did not know any of the students or their background so did not know that I had been a paramedic before but had to let my certification lapse due to various reasons and was taking the entire course again to update my skills and education level. She was at first very reluctant to allow me or any other student perform any type of procedure,but most of us found that as long as we approached her with the attitude of teach me rather than I know everything we were allowed to take on a role of more and more responsibility. As long as we go into things with th right attitude we will find that most nurses do not hate students what they have a problem with is that they have seen too many students come in with too high of an opinion of themselves.

 

[VentMedic]

When you went to school FT as a FF/medic, did how much irreplaceable time did you lose with your children? They only grow up once. Or was this before children?

Do you understand the word "choice"? What is this selfish need you have for all nursing students to take 6 years to finish a 2 year program just so you can go?

It is very simple...if you can't cut it or have other priorities, don't go back to school. The FD doesn't care if you are a nurse.

Do you understand there is not enough money and resources to design professional programs around every individual? Why should a FF be made the exception? Maybe not everyone wants to stretch out their program to 6 years. But, isn't that the EMS way for some? Take a 110 hour course and stretch it out to a year by going 1 night a week just to say you attended a "year long" EMT program.

People have found ways to get an education long before you and will continue to do some. Most are mature enough not to make an excuse for every little thing. They have their goals in mind and do it. You obviously don't want this bad enough or you would have already had a degree. You are well into your 30s and are still whining like you are in elementary school looking for a reason to play hooky. Do you honestly think your attitude would be welcome in any college level program which has serious students who have made adjustments in their lives to get an education?

Besides, how many of these older nurses got their start with a simple diploma?

Do your realize that diploma was over 2 years in length and required the students to live in a dorm in some programs? Do you realize those living in the dorms were also subject to being on call as extra hands at any time of the night? There are still several of these older nurses around from these programs that believe the 2 year degrees are too easy on the students.

There is no way EMS in the U.S. will ever require anything more than a few hours of training due to some of the attitudes it attracts. Many of the FFs who do have a good career don't want to put forth the extra effort which is also why they have gotten the bad reputation when it comes to providing EMS. Some want too many shortcuts and exceptions made for the poor FF who already has another job and EMS really is just something extra to get the funding. Isn't that how you are viewing the RN? It is just something a little extra for some additional money? It's not really a career for you but more of a hobby so you don't have any time to spend on it. Thus, you selfishly want other nursing students, who will make the RN a career, to do the program in a way that takes care of you and the hell with the rest.

You can't see why some older nurses would not want to precept someone like you who is constantly whining, making excuses and looking for shortcuts?

 

[Level1pedstech]

Maya, let me give you an ER techs view of your situation. There are several ways to improve your ER time but lets try the easy ones first.

Having seen many students of all levels pass through our ED over the years I can tell you that your success lies in your ability to exercise your critical thinking skills and be two steps ahead of the game from the time you start your shift. If you spend your time waiting for someone to take your hand and show you the way you have already missed the boat. You should have been oriented to the department and should know your boundaries. Don't rely on the staff to make your clinical time a success. Most RN's really enjoy the role of teacher but that role is second to their role as RN. Even the nicest nurses and techs have bad days and like vent mentioned some have grown weary from the waves of less than stellar students that flow through the system.

The other easy solution is to try another crew and see if you gel better with a different group. We have two crews that split the night schedule and they are worlds apart in style and substance. Example, my favorite crew to shift with likes wings,pizza and other treats that are not so healthy but fun to enjoy the other crew is humus,fruit and veggies all the way, fine if your a small furry little animal but not the greatest in my opinion for late night ER snacking. One crew is really into having fun the other is more rigid and by the book. Both get the job done but the experience is compleatly different, I think you get the point.

It is so important that you make good use of your time and learn all you can while in the ER. I honestly think that clinicals can make or break most students. Books are fine but one on one contact with really sick folks is the only true way for a student to judge if health care is their calling. I have seen plenty of people who had no business anywhere near sick people and a few who just needed to break out of their shells. Please feel free to PM me if you have any questions I would be happy to help you make the best of your ER time.

 

[Level1pedstech]

Have you noticed the nurse bashing threads on the EMS forums?

The student, especially for Paramedic, must remember that the hospital is extending a learning privilege to the school which can be taken back. It is becoming harder to find hospitals that even allow clinicals for Paramedic students due to attitudes and screwups from improper training/education and screening in the Paramedic programs.

Many of our hospitals no longer allow ETI in the ED by Paramedic students and IV starts were almost lost also due to the ignorance of a few students. They were racing each other starting IVs the "EMS way" with very little care for the site or for the patient. The L&D and Neonatal unit are also off limits and there is a very limited access to the Pedi ICU.

Great points and well worth mentioning. I can tell you from my own observations that the students are the ones that cause the problem and in the future may find it hard to even get ER time let alone clinical time in other specialties. We still allow medic students in the OR,L+D,ICU and PICU but it might not be long until we restrict our units. I think its like many other problems that stem from the practice of allowing anyone with a pulse and a bank account into some of these programs. There are always going to be people that ruin a good thing for everyone else and its hard to filter out the problem children before its to late. This will not be the last time we touch on this subject.

 

[Veneficus]

Want to attend: Part time medical school.

Why on earth would you want that?

It is long enough as it is.

 

[JPINFV]

...but then I can work a cool ambulance gig on the side that means I won't have to take out student loans!

 

[TransportJockey]

I never had a problem during my clinicals, part of it was because I knew a lot of the staff that was in the EDs. Either from dropping off or picking up in their ED or they were staff that worked PRN there and full time at my facility where I'm a tech.

There was one day where the nurses were a little less than helpful and that was because the other medic student at the clinical site with me that day decided to mouth off to a very senior charge nurse and got himself thrown out.

 

[Veneficus]

Figured I should address the OP.

First off, nurses are human. (I know there is a lot of propaganda about being a nurse) Some humans like to teach, some do not. Some are better than others. If you don’t think you are not getting a proper education, switch to another preceptor, or even another clinical site. Ask the natives who the best preceptors are. You’d be surprised how easy that info is to come by.
Birds of a feather flock together. As pointed out, not just in the ED, people whose personalities mesh tend to work the same shift. If your personality or values clash with the shift you are doing clinicals with you will have a negative experience.

Be proactive. Often students who hang around waiting to be told are viewed as slackers, not shy or unsure. Once you are seen as a slacker, it is a tough label to break. Personally I hate students who bring books to study. If you are reading a book at a clinical site, you are unprepared and not doing what you are supposed to, which is to get hands on experience. If you really have nothing to do, ask questions. Even if you know the answer. Showing you are engaged pays dividends.

Remember who you work for. Spend some time with the doctor. The responsibilities of a nurse and other healthcare providers are different, as are their priorities. Just like working with firemen or police officers in the field, you sometimes have to give a little to get something.

Nurses are not all bad. I have many friends who are nurses, as well as being the student of some outstanding preceptors who were nurses. Just like anyone, there are bad apples. You have to steer clear of them.

Don’t forget some nurses know it all. In my experience some of them seem to bash everyone for their lack of knowledge. Paramedics, doctors, radiology techs, respiratory therapists, and even other nurses; sometimes it seems nobody knows as much as they do.(especially evident in 4 year programs) I especially like to read the professional nursing journals that have doctor bashing articles. Just like spoiled children, being told how great/important you are all the time has a profound effect.

Even among staff from other fields, some EMS schools have a stigma about them. If the staff are used to a lack of quality from your program, right or wrong, it always manifests. Then you need to go the extra mile just to get out of the hole.

Most important, help out! Sure you are there to learn/practice certain skills, but in any ED I have been a part of, there is always more to do than people to do it. Ask if you can help do some of the less glamorous tasks. I don’t know anyone who would turn down help changing soiled linens.

Be an asset. Just like in EMS, vitals need to be updated every so often. Just do it. Then give it to the nurse for her to chart. Get the patient a cup of water. (make sure it is ok for them to have it first) Try to help patients be more comfortable. It makes life easier for the nurse. If one presses a call light, respond and see if you can help. I have found great success in simply explaining to patients how long regular events take. (like lab work) I also like to remind them in the hospital no news is good news. When providers are flocking to your bedside, a patient should probably be worried. This takes pressure off of the nurse. Additionally if a patient needs to be pushed across the hall, a bed made, etc. Ask if you can do it.

Most nurses I know are assigned a “pod” or an area of some kind. They probably have to stock it. Ask them if you can help. If equipment needs tested ask them to show you how.

Find out about the patients your preceptor is assigned to, don’t just walk around looking for skills practice.

Also don’t forget to give your preceptor some space. It also helps to tell people what you are permitted to do and what you need to get done. (IVs assessments, etc.)

Most important. There is no such thing as "field medicine." The principles of medical science are always the same. Sometimes the techniques may vary, when in Rome do as the Romans do. Nobody cares how "it really works in the field," or how "paramedics do it."

 

[Veneficus]

...but then I can work a cool ambulance gig on the side that means I won't have to take out student loans!

Let me know what ambulance company pays enough to cover the costs of medical school, I will apply straight away.

 

[mississippimedic]

The best advice that I could give is to stay busy. If you are at a slower hospital don't just sit around and play with your black berry or similar device. If you have nothing else to do bring your text book and study. Interact with the staff ask them any questions you may have. We didn't really have any problems with clinicals, we knew what was expected of us. If we made problems for the hospital staff depending on the severity, we had one chance. The second time a student made trouble he would likely be dropped from the program. I wouldn't worry about the nurse you spoke of, she may have had a bad day or like anywhere you go, you will always find at least one Ahole. Just keep a positive attitude.

 

[VentMedic]

Don’t forget some nurses know it all. In my experience some of them seem to bash everyone for their lack of knowledge. Paramedics, doctors, radiology techs, respiratory therapists, and even other nurses; sometimes it seems nobody knows as much as they do.(especially evident in 4 year programs) I especially like to read the professional nursing journals that have doctor bashing articles. Just like spoiled children, being told how great/important you are all the time has a profound effect.

Nurses are also feeling the pinch of being one of the least educated licensed professionals in the hospital setting. One could also include the administrative staff who generally have Masters. The BSN is becoming the way to go in nursing to make oneself marketable. Even the Respiratory Therapists are now petitioning for the Bills that will recognize their status with Bachelors and Masters. They, RRTs and RNs, realize they are way behind the other Allied Health professions in education with just a mere Associates degree. Nurses also see their status slipping everyday in the Multidisciplinary meetings. Thus, the BSN is not one of arrogance but rather one of survival now in an ever changing world of medicine.

Then, you get a few in a Paramedic program that brag about being "doctor like" with just a few hundred hours of training to do a few cool skills while the RNs are going back for the BSNs and MSNs just stay competitive, it can become a little tense. Of course the Paramedic also symbolizes a time when LVNs were allowed in acute hospital settings where they could do a lot with very little education. The same when Respiratory and Radiology Techs were just certificates from 1 year schools. Those times where only skills were adequate for a job are gone as the knowledge must now be there. Unfortunately some Paramedics still only focus on "skills" and do not respect the "knowledge" that other professionals have or they believe the nurse has nothing to offer them because the Paramedic "is close to being a doctor". They also get so wrapped up in the "skill" that they forget to see there is so much more to patient care. The RN must not only be concerned about "skills" but also plan total patient care be it for discharge or admission to the floor.

 

[VentMedic]

If you have nothing else to do bring your text book and study.

I agree with Veneficus about this. If we see you bring a book to clinicals, the first thought is you are behind and plan to use the time as a study hall period and probably don't want to be bothered with what the ED staff has to offer.

Also, if you can not find something to do in an ED no matter how slow it is, then that just demonstrates how little you do know and should seek out more information from the staff in that ED. Even reading the volumes of protocol and procedure manuals that nurses have can be enlightening. Few Paramedics understand how nurses function or what happens to their patients after they arrive at the ED. Even looking over the various assessment paperwork that RNs much complete can give the Paramedic student a look into how many detailed assessments are involved in patient care for the long haul. Each diagnosis and procedure can generate a new care plan for assessment with a different focus.

 

[Veneficus]

Nurses are also feeling the pinch of being one of the least educated licensed professionals in the hospital setting. One could also include the administrative staff who generally have Masters. The BSN is becoming the way to go in nursing to make oneself marketable. Even the Respiratory Therapists are now petitioning for the Bills that will recognize their status with Bachelors and Masters. They, RRTs and RNs, realize they are way behind the other Allied Health professions in education with just a mere Associates degree. Nurses also see their status slipping everyday in the Multidisciplinary meetings. Thus, the BSN is not one of arrogance but rather one of survival now in an ever changing world of medicine.

Unfortunately I see it manifest as arrogance all the time. Could it be that the reason nursing is being marginalized is because the profession has tried to move beyond the required role? Medicine has many researchers with advanced degrees. Who needs one more? Especially one with a BS? Is nursing really a science or a BA marketed as a science and its lack of basic science evident? What about the nurse being a "manager" or unlicenced staff? Many hands on providers look down on paper pushers. There is also the question of nursing's drive to make everything routine. Perhaps routine leads to complacency?

I am not a nurse. I don't know the reasoning, only what I see. These are questions I have no answers to, only a perspective to consider.

Then, you get a few in a Paramedic program that brag about being "doctor like" with just a few hundred hours of training to do a few cool skills while the RNs are going back for the BSNs and MSNs just stay competitive, it can become a little tense. Of course the Paramedic also symbolizes a time when LVNs were allowed in acute hospital settings where they could do a lot with very little education. The same when Respiratory and Radiology Techs were just certificates from 1 year schools. Those times where only skills were adequate for a job are gone as the knowledge must now be there. Unfortunately some Paramedics still only focus on "skills" and do not respect the "knowledge" that other professionals have or they believe the nurse has nothing to offer them because the Paramedic "is close to being a doctor". They also get so wrapped up in the "skill" that they forget to see there is so much more to patient care.

I think nobody in the right mind would dispute this.

The RN must not only be concerned about "skills" but also plan total patient care be it for discharge or admission to the floor.

An advanced practicioner such as a NP or CRNA may have these responsibilities, certainly not the average RN. In the hospitals I am affiliated with both home and abroad, it is still the doctor than plans patient care and arranges for admission or discharges. Nursing carries out these directives.

Sure they have their nurse to nurse reports and other administrative procedures, but they are certainly not the primary decision makers. Just like many paramedics, to me, many in nursing seem to want decision making capability without responsibility. One without the other is simply impossible. I strongly suspect that same idea of authority without responsibility plays a significant role in their being marginalized in multidiscipline gatherings.

 

[VentMedic]

Unfortunately I see it manifest as arrogance all the time. Could it be that the reason nursing is being marginalized is because the profession has tried to move beyond the required role? Medicine has many researchers with advanced degrees. Who needs one more? Especially one with a BS? Is nursing really a science or a BA marketed as a science and its lack of basic science evident? What about the nurse being a "manager" or unlicenced staff? Many hands on providers look down on paper pushers. There is also the question of nursing's drive to make everything routine. Perhaps routine leads to complacency?

You think a 4 year degree is too much for an RN? Gee! What an insult! You must also have a seriously low opinion of OTs, PTs and SLPs as well.

And you believe nurses have no role in research? Are you even aware of the research that they have been doing for decades? You must really be shocked to know there are RRTs with Ph.Ds who also do research. I've even heard they exist in ALL the other licensed health care professions. How shocking!

There is a difference between routine and have a standard plan of care as a guide to ensure as little as possible is missed in the performance of patient care.

An advanced practicioner such as a NP or CRNA may have these responsibilities, certainly not the average RN. In the hospitals I am affiliated with both home and abroad, it is still the doctor than plans patient care and arranges for admission or discharges. Nursing carries out these directives.

What "skills" are you thinking about? There are more "skills" than intubation and IVs.

Are you even aware of care plans that RNs make out or those that are done as multidisciplinary plans for review with a team which does include a doctor. A doctor does NOT have to time to prepare one of these which are now required for each and every patient.

Also have you ever heard of Case Managers who are nurses? The doctor says "discharge" and it is up to them to figure out how, when and where. Very few doctors get involved in the actual details of discharge except for writing the scripts for meds.

Sure they have their nurse to nurse reports and other administrative procedures, but they are certainly not the primary decision makers. Just like many paramedics, to me, many in nursing seem to want decision making capability without responsibility. One without the other is simply impossible. I strongly suspect that same idea of authority without responsibility plays a significant role in their being marginalized in multidiscipline gatherings.

You are not a nurse. You obviously do not work with nurses and you really don't know what they do. Do you even know what the role of multidisciplinary meetings are and how they differ in the various patient care areas? Ever hear of a little agency called JCAHO? Do you know what their tracers consist of? Ever hear of nurse driven protocols? Do you honestly think one physician can micomanage all the care that is involved with just one patient?

You seem to think that some low level health care worker like a nurse should know their place and be happy with just the required entry level education. You seem to think if they get more education they are arrogant and believe they are better than doctors. There seems to me like you have some misbeliefs about education and the world of medicine. Like it or not other health care professionals are seeing the importance of education as medicine and technology advances. Nurses no longer wear short white dresses and want to sit on doctors' lap to give them a good time at work in hope of marrying one. Times have changed.

It is disgusting that there are such attitudes towards educated health care professionals in the year 2010.

I figured this would turn into another nurse bash thread.

 

[Veneficus]

You think a 4 year degree is too much for an RN? Gee! What an insult! You must also have a seriously low opinion of OTs, PTs and SLPs as well.

I am not sure how you came to that conclusion. I think you over reacted to the point I was trying to make, which is that it is possible to have too many people managing and not enough providers actually performing care.In smaller words, the chief to indian ratio. Of course you wil now probably level an accusation of my bias against native cultures. Having a host of aids and techs to perform nursing duties is economcally unsound. It also devalues a nurse to the role of "middle manager." If you look at expendable persons in any industry, middle management is not the place to be.

And you believe nurses have no role in research? Are you even aware of the research that they have been doing for decades?

I have been living in a hole all my life, I have no idea of the world around me.

I believe that researchers should have advanced degrees. At least a master's. Many nurses I know agree that too much emphasis in the 4 year degree is placed on research and not enough of patient care, am I evil incarnate for having the same opinion because I am not a nurse?

You must really be shocked to know there are RRTs with Ph.Ds who also do research. I've even heard they exist in ALL the other licensed health care professions. How shocking!

People with Ph.Ds do research? Amazing!
I am not sure why you felt this would add anything.

There is a difference between routine and have a standard plan of care as a guide to ensure as little as possible is missed in the performance of patient care.

Sounds to me like a cookbook. I thought cookbook medicine was bad medicine. Oh well, I guess I am going to hell.

What "skills" are you thinking about? There are more "skills" than intubation and IVs.

I have reread my post, I cannot find where I mentioned skills. I did mention that advanced nursing providers have considerable resposibilities compared to an RN. Perhaps I am mistaken?

Are you even aware of care plans that RNs make out or those that are done as multidisciplinary plans for review with a team which does include a doctor. A doctor does NOT have to time to prepare one of these which are now required for each and every patient.

I have been party to many multidisciplinary meetings. In my observations in such, I have noticed that more weight is given to any party that provides direct care over parties that simply administrate, regardless of title or degree. I have also noticed that the doctor does tend to listen to and sign the plan.

Also have you ever heard of Case Managers who are nurses? The doctor says "discharge" and it is up to them to figure out how, when and where. Very few doctors get involved in the actual details of discharge.

My point was it is not the nurse that makes the decision to discharge, but carries out the directive. Not only was that what I said, you quoted it verbatim. You then question whether or not I have heard of a nurse that carries out the details of the doctor's directive?

You are not a nurse. You obviously do not work with nurses and you really don't know what they do.

I wonder how you can possibly make such a statement. I am not a nurse. (I think I said that.) In all of my hospital and educational experience is it possible I do/have not worked with a nurse? How could I possibly know the responsibilities of my coworkers and friends? While passionate, I don't think you put much thought into this statement. It seems you were merely hell bent on leveling a personal attack.

Do you even know what the role of multidisciplinary meetings are and how they differ in the various patient care areas? Ever hear of a little agency called JCAHO? Do you know what their tracers consist of? Ever hear of nurse driven protocols? Do you honestly think one physician can micomanage all the care that is involved with just one patient?

Ignoring the fluff, isn't a protocol a standing order? A set of guidlines of which care is based? I wonder who signed off on these "protocols?" I don't recall suggesting that physicians micromanage care, but for some strange reason physicians do like to be involved in care and decision making. Perhaps you are suggesting that a physician is superfluous in the care of patients?

You seem to think that some low level health care worker like a nurse should know their place and be happy with just the required entry level education.

I don't think you understood what it is I said. Is there a language you would be more comfortable with I could have translated? Again, I stated that if people no longer perform a valuable function, they would eliminate their own position. What a person or professions wants to do and what is needed do not always coincide.

You seem to think if they get more education they are arrogant and believe they are better than doctors.

I stated that I have witnessed nurses who exhibted that type of behavior. I also stated that I have seen nursing publications that had articles printed about the inappropriate treatment of patients by doctors. I do perceive that to be arrogant, just as I would perceive a paramedic who believed they knew more about healthcare than a nurse to be arrogant.

There seems to me like you have some misbeliefs about education and the world of medicine. Like it or not other health care professionals are seeing the importance of education as medicine and technology advances.

I don't think that "medicine" and "healthcare" are synonymous. I would be more convinced they were if the educational coursework were more similar. (more basic science and less "fundamentals of nursing") I have yet to take a class in "fundamentals of medicine" or "fundamentals of physicians."

I also don't think my academic pondering of roles and value in healthcare is an attack on education or a profession. Furthermore, I think that being critical of EMS education, roles, and value without being critical of other professions is a bit biased. Certainly not conducive to improvement in healthcare quality, patient care, meaningful debate, or research.

Nurses no longer wear short white dresses and want to sit on doctors' lap to give them a good time at work in hope of marrying one. Times have changed.

Very colorful. Other than attempting to deter healthy debate, what is this statement supposed to accomplish?

It is disgusting that there are such attitudes towards educated health care professionals in the year 2010.

Is it as disgusting as creating a strawman argument and leveling personal attacks about knowledge, experience, and observations in order to suppress academic discourse?

I figured this would turn into another nurse bash thread.

I offered my observations, put forth topics of debate based on such. Is that really bashing?

Would it be fair to say if we cannot debate other healthcare professions roles and values that we are limiting this forum to EMS bashing?

 

[VentMedic]

I am not sure how you came to that conclusion. I think you over reacted to the point I was trying to make, which is that it is possible to have too many people managing and not enough providers actually performing care.In smaller words, the chief to indian ratio. Of course you wil now probably level an accusation of my bias against native cultures. Having a host of aids and techs to perform nursing duties is economcally unsound. It also devalues a nurse to the role of "middle manager." If you look at expendable persons in any industry, middle management is not the place to be.

Now you are calling OTs, PTs and SLPs "techs"? You really have a very low opinion of health care professionals.

I have been living in a hole all my life, I have no idea of the world around me.

Obviously.

I believe that researchers should have advanced degrees. At least a master's. Many nurses I know agree that too much emphasis in the 4 year degree is placed on research and not enough of patient care, am I evil incarnate for having the same opinion because I am not a nurse?

Do you know that in most major cities there are more BSN programs than ADN? Do you know it has been that way for about 3 decades now? If you do not know what a nurse does, how are you the one to just that they don't do any patient care if they have a BSN?

People with Ph.Ds do research? Amazing!
I am not sure why you felt this would add anything.

Because you seem to not believe anybody except a medical doctor can have "education" and definitely don't need another profession doing research with all the doctors around. You just stated that in your previous post.

Sounds to me like a cookbook. I thought cookbook medicine was bad medicine. Oh well, I guess I am going to hell.

Protocols and guidelines. Even doctors have them. You implied the nurses are useless unless an order is written for every procedure they do. News flash for you; no doctor would have time for that.

I have reread my post, I cannot find where I mentioned skills. I did mention that advanced nursing providers have considerable resposibilities compared to an RN. Perhaps I am mistaken?

I mentioned the skills and you replied only the advanced practitioners. Try listing every skill that an RN does or even the LVN. You might be amazed. I have Paramedics do this when they believe they do a lot of skills for an eye opening experience.

I have been party to many multidisciplinary meetings. In my observations in such, I have noticed that more weight is given to any party that provides direct care over parties that simply administrate, regardless of title or degree. I have also noticed that the doctor does tend to listen to and sign the plan.

I do not mean a bedside report which a doctor signs that he/she saw the patient but a multidisciplinary meeting that satisfies the JCAHO requirements. There is a difference and every unit or patient care area has their own meetings and plans.

My point was it is not the nurse that makes the decision to discharge, but carries out the directive. Not only was that what I said, you quoted it verbatim. You then question whether or not I have heard of a nurse that carries out the details of the doctor's directive?

Do you know what all is involved in the discharge of a patient. Yes the doctor writes the word "discharge" but do you really know what happens after that?

I wonder how you can possibly make such a statement. I am not a nurse. (I think I said that.) In all of my hospital and educational experience is it possible I do/have not worked with a nurse? How could I possibly know the responsibilities of my coworkers and friends? While passionate, I don't think you put much thought into this statement. It seems you were merely hell bent on leveling a personal attack.

The statements you have made against nurses do not speak of experience. In fact, you seem hell bent on "putting nurses" in their place by bashing those that dare to get a BSN. I can't imagine what you must think of a Paramedic that dares to get a two year degree.

Ignoring the fluff, isn't a protocol a standing order? A set of guidlines of which care is based? I wonder who signed off on these "protocols?" I don't recall suggesting that physicians micromanage care, but for some strange reason physicians do like to be involved in care and decision making. Perhaps you are suggesting that a physician is superfluous in the care of patients?

Yes the nurse work under protocols that are signed off by physicians and they also work under those that do not require a doctor's signature to provide total patient care. Do you think a doctor wants to get involved in what equipment to order, wound care surveilance or any of the hundreds of things that go into total patient care? Do you think the physician should write for how many times to dump the foley because by your reasoning, the nurse is too stupid for that and must have a doctor signed order.

I don't think you understood what it is I said. Is there a language you would be more comfortable with I could have translated? Again, I stated that if people no longer perform a valuable function, they would eliminate their own position. What a person or professions wants to do and what is needed do not always coincide.

Do you honestly think education will lead to the extinction of a profession? PTs have a doctorate and they are now in serious demand. Do you believe the nurses should just go back to being known as "bed pan dumpers" rather than professionals in health care? What about all the other professions that have now achieved worth and recognition by insuring agencies because of their education? Do you even realize how much medicine is advancing and the technology that is used today that requires people to have advanced education?

I guess you also support the EMT staying at 110 hours of training and the Paramedic to stay at 700 hours.

I stated that I have witnessed nurses who exhibted that type of behavior. I also stated that I have seen nursing publications that had articles printed about the inappropriate treatment of patients by doctors. I do perceive that to be arrogant, just as I would perceive a paramedic who believed they knew more about healthcare than a nurse to be arrogant.

Yes and we just has a doctor arrested for child porn again. We've also had doctors arrested for molesting their patients. Sometimes a nurse or any other professional has to be a patient advocate. If a doctor writes an order that can harm a patient, it is the nurse's responsibility to point it out whether the doctor likes it or not. If a nurse makes a med error he/she must also answer for it.

I don't think that "medicine" and "healthcare" are synonymous. I would be more convinced they were if the educational coursework were more similar. (more basic science and less "fundamentals of nursing") I have yet to take a class in "fundamentals of medicine" or "fundamentals of physicians."

Do you think nurses are only educated out of one "Fundamentals of Nursing" book? They do have a text book entitled Critical Care Medicine. How about Pediatric Primary Care? One of my many textbooks were titled "Respiratory Medicine". However, I do not claim to be a medical doctor because of the title but I also believe RT and the RN are very much a part of medicine.

I also don't think my academic pondering of roles and value in healthcare is an attack on education or a profession. Furthermore, I think that being critical of EMS education, roles, and value without being critical of other professions is a bit biased. Certainly not conducive to improvement in healthcare quality, patient care, meaningful debate, or research.

Very colorful. Other than attempting to deter healthy debate, what is this statement supposed to accomplish?

You have made belittling statement about nursing and other health care professions. You have essentially stated that the RN should not become educated which puts them back into short skirts sitting on the doctor's lap like in the soaps. You believe they should remain uneducated fools that only know how to say "yes doctor" and have no say in patient care.

Is it as disgusting as creating a strawman argument and leveling personal attacks about knowledge, experience, and observations in order to suppress academic discourse?

You made it personal by attacking educated health care professionals which I happen to be in that category. Your belief that only the medical doctor should have higher education and all the others should be known as techs and not professions is outdated for modern medicine.

I offered my observations, put forth topics of debate based on such. Is that really bashing?

Would it be fair to say if we cannot debate other healthcare professions roles and values that we are limiting this forum to EMS bashing?

If you can not accept a BSN for nurses, I can not see you ever advocating for education in EMS. Afterall, EMTs and Paramedics must follow protocols just like nurses. Even a 2 year degree for the Paramedic must seem absurd to you. And yes, I've got one of those as well in EMS.

 

[firetender]

Dear VentMedic

I respect your contribution to the site, your experience, much of what you stand for, and I appreciate the time you take to share your knowledge and experience with those coming up in the ranks.

AND...

If I hadn't been seeing a pattern I'd keep my mouth shut. But just a couple minutes ago, I found myself stepping away from learning anything constructive from you because, quite frankly I wasn't willing to keep running in to two arrogant invectives for every kernel of wisdom you offered.

...and I could be a little off base here, taking into consideration how typing is no substitute for face-to-face meeting, but what happens to me when I run in to a clearly disdainful comment toward a poster or one of a poster's thoughts or positions, I become prejudiced and skeptical of whatever follows. Now that turns in to a lot of work for me to learn something from you, doesn't it?

I get and appreciate the whole Kali, Warrioress; protector of the brood aspect of you and your work, and, at the same time, recoil from some of your approaches which are all about resistance and underneath it all, what comes through is anger.

I really don't care if your anger is all about the ideas you have around protecting your patients or profession(s). This Forum is just WORDS! Anger is anger and I don't want to be around it. AND I don't want to miss what you say!

I'm not perfect myself; you've pointed that out and I've accepted it and looked at it and even did use the reflection you prompted in me to make changes in attitude. Now, I'm asking you to hear me, and ask that you accept the offer as a sign of friendship, for all of our benefit.

 

[Maya]

Thank you for all of the advice! I can already see a few things that I am going to try to do differently. When I wrote the OP, I had just gotten off of that last shift and was so frustrated, especially since that nurse had so obviously lied to me about the patient who she said was a bad stick. It just felt like such a slap in the face.

I guess, from my perspective, I have only 200 clinical hours to perfect my skills before I am out in the field doing my internship. I will sign up for more hours if I feel that I still need improvement once clinicals are over, but it's really frustrating to stand around for eight hours doing nothing besides changing sheets. All of the medics I've talked to have said that I should be getting 20-30 IV's started in one shift and I'm getting maybe 2 or 3. I can get the minimum number of patient contacts that I need to pass my clinicals, which is 40 IV starts and 10 live intubations--but what kind of medic will I be if I've only performed the minimum number of skills?

The way I see it, this is a really small community. It's only a matter of time before I'm in the back of an ambulance with one of the ER staff's friends or family members. I won't have a team of doctors and nurses to help me. I'll have an EMT and maybe a couple firefighters if I'm lucky. If I'm running a Code and I'm 15-30 minutes from the hospital, can't get an IV started to push meds and can't get the patient intubated, it sucks for me as a medic, but it REALLY sucks for the patient. They could die. I really don't want to be fumbling around, practicing my skills in the field during a code. I would like to be doing it in the hospital, in a controlled setting, the way I'm supposed to be.

Taking a step back, I can understand why the nurses would be protective of their patients. It's really unfortunate that they would have a bad impression of medic students just from past experiences. I've already requested to do the rest of my clinicals at another hospital. I didn't tell the clinical coordinator why, because I really didn't want to make a big deal about it. I still have 2 more weeks at this hospital though, so I'm going to do my best to relax, be nice, be ridiculously helpful, and will come armed with large quantities of sugary baked goods to appease the nurses. I don't want to give the medic class a bad reputation at this hospital and spoil it for everyone else.

Thank you for all the insight, you guys! I'll work on writing my patient assessments in my downtime, have fun, and just see what I can help with around the ED, whatever that may be!

 

[VentMedic]

My dearest firetender,

I am not the type that will sit back and allow someone to state that the many health care professions are not part of medicine. Nor will I remain quiet while someone states that those in the many health care professions remain as "techs" since education will make them arrogant even at a 4 year degree level. To want those in health care to not obtain higher educational goals because "they only take orders from the doctor" is just absurd. I will continue to emphasize that the world of medicine is constantly evolving and that one should not just do the bare minimum if they are serious about a career in any of the health care fields.

I seriously do not want some to believe that nurses or any health care professional are stupid or arrogant because of their career choice and no health care provider should be criticized for advancing their education or belittle by those who think "they should know their place" and not try to know more then the bare minimum to do a skill or a task.

I have argued these points for 30 years in EMS and I also have had the opportunity to see how education brings professional growth to the many professsions in the hospital. I will not sit back quietly and allow someone attempt to say higher education in health care is not necessary and a privilege reserved only the medical doctors.

I would like the many health care professions to understand each other. Those in the hospitals have had to come to agreements because of the many regulations that demanded a working team effort be created for the good of the patient. Education was also a large part of leveling the playing field for the many different health care professions. The advanced education and research efforts have led to many innovations in improving patient outcomes. I just can not sit quietly when one can not see how education at the frontlines of patient care can not be of benefit for anything other than to promote arrogance. I also do not want those just starting out and trying to find a path for themselves to believe education is the root of all evil in health care....that is unless you are a doctor.

I will also continue to push those in EMS to get more education because a few hours of training is not enough for the responsibility they have been trusted with. For those who believe those few hours entitle them to more respect than any other profession because of a few impressive skills, I do encourage them especially to go back to college.

 

[VentMedic]

It's really unfortunate that they would have a bad impression of medic students just from past experiences.

It is a little more than just a few experiences from students. Our ED sees well over 100 ambulance crews (both private and FD) each day. The ED staff gets to see both the good and the bad from all of these crews. There are some days where we would love to detour all crews to another hospital or just lock the ED doors allowing only the patients in because of the bad apples on that particular shift. There are other shifts where the EMT(P)s get invited to our gatherings both in and outside of work.