Paramedic to RN bridge….. options?

[CCCSD]

I’m misunderstood.

I’m not by any means crapping on nurses and degrading the importance.

I’m used to the EMS profession being degraded on a daily basis. It’s normal. I have respect for my nurses and I would never bash the profession as a whole. For me personally, after going through the school… I did not feel like I wanted to be apart of the American health care system anymore.

Wow… Sooo much better everywhere else, eh? You aren’t misunderstood. Not at ALL.

You don’t HAVE to do this line of work, and should be focusing on anything but…

 

[LoadingCosta]

Wow… Sooo much better everywhere else, eh? You aren’t misunderstood. Not at ALL.

You don’t HAVE to do this line of work, and should be focusing on anything but…

Thank you. I am focusing on trying to find a new career path. Just trying to take into account my age at this point in my life. I think it’s time for me to stop responding because I feel like this thread is going in a bad direction and this was not my intentions at all from the beginning. I do really appreciate everyone who did share advice and wisdom. It is very appreciated. Trust me. I appreciate all you and everything you all do in your past and current professions!

 

[akflightmedic]

Because I’m not allowed to function as a paramedic in a hospital setting.

So I’m in the wrong when there was 5 nurses in the room and 3 doctors and two PAs working in the ER?

You are correct. This is completely my fault and I should of stepped into that Covid room without proper PPE and shocked that patient.

Ill remember that for next time.

Yes, it absolutely IS your fault. For many reasons...

1. Your story has now changed or been amended to add other professionals to the equation, when originally it was described as a nurse who could not function until told to do so by a provider.
-What you now describe sounds like a leadership issue, not a scope issue. Too many chefs in the kitchen.

2. You also had a timer running, however initially laid all responsibility on the sole nurse, when actually there was an entire team there, all too dumb to know what to do.
-This is where it is your fault because you saw something, yet chose to say nothing. Medicine is a Team Sport, always. Instead of being smug and watching a clock, use your mouth. It is not license restricted, I assure you. Not speaking up and allowing others to fail is a horrible way to proceed through life and medicine. Do us a favor, and chase a different career.

*And it is now a COVID room so you could not step in...could not knock on the glass, could not knock on the door, could not open mouth. None of which require PPE or jeopardizing your safety. FYI, you can pretty much assume everyone has covid right now, we are two years into this and I find it comical how we do not PPE for the ankle fracture kid probably has covid but not being tested, however the known covid is uber PPE cautionary tale.


Save your too cool for school stories for some other group you wish to disrespect. And no, I am not defensive because you told it about a nurse. It is how you told the story, it is about facts you left out, and it is your unwillingness to speak up when you see something wrong, and moreso simply clock watch, shrug your shoulders and say "not my job" or "not allowed to be a medic in ER".

 

[LoadingCosta]

Yes, it absolutely IS your fault. For many reasons...

1. Your story has now changed or been amended to add other professionals to the equation, when originally it was described as a nurse who could not function until told to do so by a provider.
-What you now describe sounds like a leadership issue, not a scope issue. Too many chefs in the kitchen.

2. You also had a timer running, however initially laid all responsibility on the sole nurse, when actually there was an entire team there, all too dumb to know what to do.
-This is where it is your fault because you saw something, yet chose to say nothing. Medicine is a Team Sport, always. Instead of being smug and watching a clock, use your mouth. It is not license restricted, I assure you. Not speaking up and allowing others to fail is a horrible way to proceed through life and medicine. Do us a favor, and chase a different career.


Save your too cool for school stories for some other group you wish to disrespect. And no, I am not defensive because you told it about a nurse. It is how you told the story, it is about facts you left out, and it is your unwillingness to speak up when you see something wrong, and moreso simply clock watch, shrug your shoulders and say "not my job" or "not allowed to be a medic in ER".

Absolutely. I apologize for any disrespect or “too cool” stories. Was never my intention and apparently somewhere along the lines a lot was taken way out context. You clearly have a lot of built up hostility somewhere. It’s understandable. The healthcare system is burdened right now especially with Covid still raging.

You probably assumed I think all nurses need to ask for orders or wait for orders. That is not true from my perspective. I can’t speak on others. Doesn’t matter how many times i explain it won’t matter. I don’t think it’s about the “facts” I left out. Again I’m not going to sit here and argue with you when it’s not worth it over something so misunderstood.

Again, I really do appreciate you and all the nurses who work during these times. I respect you all. Thank you for what you do.

 

[akflightmedic]

You neglected to address why you never spoke up...

At the root of all this...nothing to do with hostility. Everything to do with integrity.

 

[MonkeyArrow]

Fresh example from last night: I get a bradycardic/hypotensive from EMS, rate 52, systolic 53, feels disoriented and weak, 70 years old, visual disturbances. Rapid assessment, stroke scale, the usual exam for this type of pt. I start a line that actually works, but then it blows. I dropped an EJ, started fluids wide open. I ordered a CT w/o contrast STAT, 12 lead, and ordered all labs including lactic, threw in cultures even though currently afebrile, cause daughter shows up and mentions there was a fever earlier in day. Go ahead and order covid swab. Unable to pee, so straight cath for a sample as she is fairly dry. I then went and gave the Provider a rundown, no further orders, answered a few questions.

This is absolutely NOT what should be happening, and I will die on this hill. This patient, as described, is critically ill and needs to have a physician at the bedside immediately. Playing hero and doing all this stuff without notifying a physician to come to the bedside is poor practice and not in the patient's best interest.

 

[CCCSD]

This is absolutely NOT what should be happening, and I will die on this hill. This patient, as described, is critically ill and needs to have a physician at the bedside immediately. Playing hero and doing all this stuff without notifying a physician to come to the bedside is poor practice and not in the patient's best interest.

Guess you didn’t read the post. ALL of the things you are so worried about CANT happen until the labs, tests, limes, meds are starte. What planet are you on where you think only an MD can do these things. Hint: MD not needed.

I was doing much the same as an IDC WITHOUT my PA present and we didn’t have an MD in house.
This ain’t 1950s Marcus Welby medicine.

 

[akflightmedic]

Ahhhh, but I am in a 9 bed free standing ER with exactly 15 patients on stretchers (several ICU or Admission holds), 2 in subwaiting, 1 in Triage 2 and a lobby with 20+ waiting, with 3 RNs on duty, no secretary, no tech, and ONE provider....is it still hero? Or is it crisis nursing at it's finest in this particular area? Cause if all you took away was me playing a "hero card"...been there, done that. So simmer down Frances....

P.S Monkey....we have MULTIPLE "criticals" just sitting here....

 

[CCCSD]

BTW. As you “Die on that hill”. Don’t expect to see an MD helping you out…

 

[MonkeyArrow]

Guess you didn’t read the post. ALL of the things you are so worried about CANT happen until the labs, tests, limes, meds are starte. What planet are you on where you think only an MD can do these things. Hint: MD not needed.

What are you even saying?

Ahhhh, but I am in a 9 bed free standing ER with exactly 15 patients on stretchers (several ICU or Admission holds), 2 in subwaiting, 1 in Triage 2 and a lobby with 20+ waiting, with 3 RNs on duty, no secretary, no tech, and ONE provider....is it still hero? Or is it crisis nursing at it's finest in this particular area? Cause if all you took away was me playing a "hero card"...been there, done that. So simmer down Frances....

P.S Monkey....we have MULTIPLE "criticals" just sitting here....

Your practice environment is apparently exceptional if you consistently have multiple peri-arrest patients at the same time in a 9 bed FSER.

 

[akflightmedic]

Are you unaware what is happening across America right now? I have been FEMA traveling non-stop since September...did a few FEMA contracts prior to this lengthy deployment.

 

[CCCSD]

What are you even saying?

Your practice environment is apparently exceptional if you consistently have multiple peri-arrest patients at the same time in a 9 bed FSER.

 

[FiremanMike]

This is absolutely NOT what should be happening, and I will die on this hill. This patient, as described, is critically ill and needs to have a physician at the bedside immediately. Playing hero and doing all this stuff without notifying a physician to come to the bedside is poor practice and not in the patient's best interest.

You know how you can make decisions and initiate treatment in the back of the medic without a doctor present due to your EMS protocol?

It’s the same thing..

 

[akflightmedic]

Quit being logical you, you, HERO! HAHAHHA

 

[MonkeyArrow]

Are you unaware what is happening across America right now? I have been FEMA traveling non-stop since September...did a few FEMA contracts prior to this lengthy deployment.

I am aware that there is high acuity across ERs in America, with no beds to admit to (ICU or floor) and no hospitals available to transfer patients out to, compounded/caused by critical staff shortages, leading to prolonged boarding of patients in the ED, causing all of the associated delays that come with that backlog. I obviously do not know the specifics of what is going on in every single ER in the country. I can tell you, between my experience and those of my colleagues around the country with whom I keep in touch, I have not heard of a setting so bad that a "provider" is unable to come to the bedside of a peri-arrest patient within a reasonable time frame.

You know how you can make decisions and initiate treatment in the back of the medic without a doctor present due to your EMS protocol?

It’s the same thing..

You know how its fundamentally different, because in the back of an ambulance, you don't have a doctor there, but in an ER, you do? (Or at least a "provider" as ak keeps saying.)

Quit being logical you, you, HERO! HAHAHHA

I see you want to engage in an adult conversation.

 

[akflightmedic]

Monkey, do you work in the USA?

I ask because you seem to not like the word Provider, which is one of the most common references to a doctor in every environment I have worked.

As for your recap of the dumpster fire we are experiencing, it is accurate, however your perception of operational flow in an ER seems quite deficient. Everything ordered and completed WAS in the best interest of the patient. No heroics involved. But according to you, "hey doc! I need you to leave that critical patient over there, and come over here to this critical patient now."....Doc..."ummm, ok, but I was about to go see that other critical that just rolled in with EMS"...no doc, it needs to be now because my patient is periarrest and my internet peers said what I described is impossible and you must do this to prevent me from being a hero and causing the patient harm.

 

[FiremanMike]

I am aware that there is high acuity across ERs in America, with no beds to admit to (ICU or floor) and no hospitals available to transfer patients out to, compounded/caused by critical staff shortages, leading to prolonged boarding of patients in the ED, causing all of the associated delays that come with that backlog. I obviously do not know the specifics of what is going on in every single ER in the country. I can tell you, between my experience and those of my colleagues around the country with whom I keep in touch, I have not heard of a setting so bad that a "provider" is unable to come to the bedside of a peri-arrest patient within a reasonable time frame.


You know how its fundamentally different, because in the back of an ambulance, you don't have a doctor there, but in an ER, you do? (Or at least a "provider" as ak keeps saying.)

I see you want to engage in an adult conversation.

A couple of things

1. The doc is available in the back of the medic at all times via radio and there are probably still services that depend on online medical control.

2. The fallacy that you’re working from is that paramedic school prepares you for independent assessment, diagnosis, and decision making and nursing school does not. You’re not the only paramedic who thinks that and before I was in nursing school I felt that way too.

You’re going to just have to acknowledge that you don’t know what you don’t know. My nursing textbooks and clinical experiences, on top of teaching significantly more detailed assessment, also go very in depth of treatment pathways.

You should do an RN OB rotation in labor and delivery someday, it’ll really blow your mind..

 

[MonkeyArrow]

Monkey, do you work in the USA?

I ask because you seem to not like the word Provider, which is one of the most common references to a doctor in every environment I have worked.

As for your recap of the dumpster fire we are experiencing, it is accurate, however your perception of operational flow in an ER seems quite deficient. Everything ordered and completed WAS in the best interest of the patient. No heroics involved. But according to you, "hey doc! I need you to leave that critical patient over there, and come over here to this critical patient now."....Doc..."ummm, ok, but I was about to go see that other critical that just rolled in with EMS"...no doc, it needs to be now because my patient is periarrest and my internet peers said what I described is impossible and you must do this to prevent me from being a hero and causing the patient harm.

Yes, I work in the US. I made a point of emphasizing provider because: 1. Many physicians don’t like being called providers (just like many PAs/NPs don’t like being called mid levels), so I don’t use (either) word and 2. I’m trying to get at the concept of what were the educational qualifications of this provider. Board certified EM MD? Old timey family medicine guy? PA? NP?

I don’t think my understanding of operational flow in an ER is lacking given I’ve spent my career in an ER and have been a “flow coordinator” (that was actually the title of my position) for several of those years, but I’m not going to get into a pissing match over who’s more qualified to opine. My point is that providers should be alerted to, and they should come to the bedside of, critically ill patients as soon as possible. If you’re running 3 codes and have a GSW in the hallway and a infant seizing in the waiting room in a 9 bed ER, well…there’s nothing I can say to that.

 

[MonkeyArrow]

A couple of things

1. The doc is available in the back of the medic at all times via radio and there are probably still services that depend on online medical control.

2. The fallacy that you’re working from is that paramedic school prepares you for independent assessment, diagnosis, and decision making and nursing school does not. You’re not the only paramedic who thinks that and before I was in nursing school I felt that way too.

You’re going to just have to acknowledge that you don’t know what you don’t know. My nursing textbooks and clinical experiences, on top of teaching significantly more detailed assessment, also go very in depth of treatment pathways.

You should do an RN OB rotation in labor and delivery someday, it’ll really blow your mind..

1. C’mon. Not even close to the same thing.
2. I never said that. My implication was, however, and something that I stand behind fully is that medical school and residency training in emergency medicine prepares you for independent assessment, diagnosis, and decision making better than nursing school thus. Therefore, when you have a peri-arrest patient, the most qualified person should be called to the bedside immediately, as soon as feasible. I guess if you work somewhere like ak does, then it’s not feasible.

 

[FiremanMike]

1. C’mon. Not even close to the same thing.
2. I never said that. My implication was, however, and something that I stand behind fully is that medical school and residency training in emergency medicine prepares you for independent assessment, diagnosis, and decision making better than nursing school thus. Therefore, when you have a peri-arrest patient, the most qualified person should be called to the bedside immediately, as soon as feasible. I guess if you work somewhere like ak does, then it’s not feasible.

Why isn't it the same thing? Pared down, your stance is that a doctor must evaluate a patient before a nurse can make a decision, but not a paramedic.

Obviously doctors have more training in medicine, but that doesn't mean they are the only people capable of identifying a problem and making a decision.