So I got fired...

[Shishkabob]

RN's do have standing orders. RN's have more medical education.

I know I'll get heat for this, but that truly is debatable.



More generalized education in all aspects of health? Sure. More education period? No.

 

[dixie_flatline]

Do you also subscribe to the theory that leaving the patient alone for 5 seconds is abandonment?

Calm down man, I was just trying to point out that leaving a trainee alone with a patient that requires IV therapy, long enough for said trainee to indulge his inner-Clooney, might be indicative of a more systemic problem. Please don't bait-and-switch by comparing that with leaving a patient alone for 5 seconds. However, if there's an ambulance chaser around, 5 seconds IS abandonment.

As for OP, I empathize, but I've been down that road before. When I was fresh out of high school, I was hired by my school district to help the district's 2 computer guys over the summer (keep in mind computers in school were pretty new back then).

At one point, I got written up because our boss told me to do Thing A. Unfortunately, Thing A turned out to be thoroughly impossible, technically speaking. I tried many different tricks, before doing the research and realizing it wouldn't ever work. Being that my boss had left shortly after tasking me, and being that this was pre-cell phones, I re-joined the rest of my group and assisted them in their task of pulling wires, figuring that was more productive then banging my head against the wall in pursuit of a fruitless task. I was written up for overstepping my boundaries or something along those lines.

A month or two later, I was approached by one of the ladies who worked for the school district (who was herself not very pleasant). She said she needed some big strong men to help her carry computers into the office. As I followed her outside to do exactly as she had asked, I noted that if she was looking for big/strong men, she should probably keep looking - I was a cross country runner, 6'2" & 160lbs soaking wet, able to bench press somewhere in the neighborhood of 50lbs. She complained that I was insubordinate and I was fired on the spot. Oh, also that day was my 19th birthday.

The guy who fired me ended up getting arrested a few years later for having a Tony Montana-like coke habit, so I guess there's that.

The point of this silly reminiscence is to note that as a subordinate employee, it isn't really for you to decide what is beneath you. I was in college at the time as a freshman studying Information Systems and I already had more experience/knowledge than the guys who were my bosses. Yeah, it bugged me, and in my opinion my firing was pretty harsh, but it was their prerogative.

 

[Veneficus]

Please don't bait-and-switch by comparing that with leaving a patient alone for 5 seconds. However, if there's an ambulance chaser around, 5 seconds IS abandonment..

I think thay may be an extreme example. Perhaps even boardering on paranoid.

The most important aspect of abandonment is the intent to discontinue treatment.

Even that has considerable caviats to it.

For example, it would be impossible to turf a call to BLS, if such literal interpretation were applied, everytime a paramedic made any patient contact, they would be obligated to continue care until another provider could be found.

It would be difficult if not impossible to care for multiple patients at once.

Even then, reasonable danger to the provider is an acceptable circumstance to leave a patient.

There is also often the need to fetch equipment or other tasks associated with care.

 

[FLEMTP]

Just because I want to beat jp to thee punch....

Protocols ARE orders.

So what if you dont even work under protocols?

Our agency doesn't. We have medical guidelines, but we are told to do what needs to be done for the patient, as long as its accepted medical practice, or we can defend our actions with sound reasoning, then we are in the clear!

I guess our standing orders are: there are no standing orders. do what you wish!

 

[8jimi8]

Does that mean you don't need someboy to help you find a vein to cannulate?

So I came upon a scene with 2 paramedics who had just inserted an EJ. I asked them if they knew what hydrocephalus was. When they looked at me sideways I said, "you are bolus'ing his brain.

 

[JJR512]

Just a note - I hope that a paramedic wouldn't leave a trainee (or even a B ) alone with a patient for any reason. There is a whole mess of reasons why that's a Bad Thing.

Is this statement absolute—a paramedic should not ever leave any patient alone with an EMT-B, period, regardless of the patient's condition or the circumstances, period? That's how it reads here. But I am aware that later you said you were just..."trying to point out that leaving a trainee alone with a patient that requires IV therapy"...is the Bad Thing.

I just wanted clarification on what you meant, because if you meant it in the absolute sense, well I'd have a problem with that. Not ever patient an ALS provider comes to requires ALS care. As Veneficus ponders, is it abandonment if an ALS provider leaves a BLS patient alone with a BLS patient? I know of Paramedic/EMT-B teams that work well together, and sometimes even with ALS patients that -B might get left alone for a moment with the patient. But that's a team of people that have worked together and work well together, and they know and trust each other.

So all I'm saying here is that I don't like the absolute way in which you phrased what I quoted. There are always exceptions that can be found.

 

[Shishkabob]

So what if you dont even work under protocols?

Our agency doesn't. We have medical guidelines, but we are told to do what needs to be done for the patient, as long as its accepted medical practice, or we can defend our actions with sound reasoning, then we are in the clear!

I guess our standing orders are: there are no standing orders. do what you wish!

Within all reason of course. Legally, protocols ARE our orders. Realistically, at least at your and my service, they don't have to be followed step by step and of course it's best judgement.


But I also know of no medic who's going to drill in to a brain to alleviate pressure...

 

[JPINFV]

We have medical guidelines,

Since not everyone with protocols are expected to consider the protocols cookbooks to be followed to the T, is there a difference between the specific noun used?

 

[Lifeguards For Life]

So what if you dont even work under protocols?

I guess our standing orders are: there are no standing orders.

I have heard those exact words come from our medical directors mouth.

 

[uberowen]

I feel like I'm reading an EMT Daytime Soap Opera with all the arguing going on in here.

 

[firetender]

Three strikes you're out. 2 down, bottom of the 9th.

As a nursing major, I couldn't stand working as a "dumbed down" tech who wasn't allowed to share and utilize what I knew.

And THAT is precisely what you also KNEW they were watching.

I was warned previously...Once I had an MD put a syringe of Viscous Lidocaine on the table while I put a foley in...its just lidocaine, right? ... "in the grey area"...I assumed it was within my scope. Maybe its my fault for not knowing my scope...the date of my second warning was in April...all was good for over 3 months...(and wasn't even "bad" when I got fired- I didn't do anything out of my scope).

Outside of your obvious contradiction and, C'mon, Jeremy, get real; you were holding a gun in your hand and pulling back it's hammer; what does that look like to an RN you KNOW who's watching your every move? J

You are a smart person. And slick, too (and not in a bad way at all!). In their eyes, you were getting ahead of yourself and them. To you, it was all about using what you know, not at all unreasonable. Unfortunately, to them it appeared dangerous. My money's on your presentation, as reflected in the first quote above, didn't help. You thought you were smart enough to get over, but three months wasn't long enough to allay their mistrust of you.

Sorry, you drew a Bullseye on your butt and got caught with your hand in the cookie jar while pushing the edge of the envelope and as a result, you screwed the pooch.

(Gimme a minute, I know there are more cliches to use here!)

Accept it. There doesn't appear to be damage done to your career movement. Get placed somewhere else and NOW and use this as a lesson in humility.

Love,
your freindly firetender

 

[dixie_flatline]

Is this statement absolute—a paramedic should not ever leave any patient alone with an EMT-B, period, regardless of the patient's condition or the circumstances, period? That's how it reads here. But I am aware that later you said you were just..."trying to point out that leaving a trainee alone with a patient that requires IV therapy"...is the Bad Thing.
....
So all I'm saying here is that I don't like the absolute way in which you phrased what I quoted. There are always exceptions that can be found.

Everything has an exception; this is definitely not an absolute. I know some EMS professionals who would say otherwise, but going to the box to get something is generally not a problem re: Abandonment. It really kind of depends on the state of the patient, how long the absence is, and a little bit of luck (if you leave what you thought was a stable pt and it takes you 1 minute to fetch something and you come back to a coded pt, well...). And turfing a BLS call down to an EMT is fine, provided the correct procedures are followed for the hand-off.

I was just pointing it out because of how the situation was described. If I heard about a medic who was precepting or otherwise responsible for a student, who left that trainee alone with the pt and this happened, I'd have a few questions is all - some for the trainee applying a tourniquet and palpating, but mostly for the medic who is in charge of the scene and the pt.

I don't think there's any more need to discuss abandonment or my earlier comment though. It's water under the bridge and it's not adding to OP's discussion.

 

[FLEMTP]

But I also know of no medic who's going to drill in to a brain to alleviate pressure...

But... isnt that why the EZ-IO was invented? I prefer to use the "obese" patient drivers to do a craniotomy btw... B)

 

[ShannahQuilts]

I know it's tough to lose your job, and I have seen a lot of really great comments in this long argument.

In the end, though, I think you are really missing a couple of the most important points: 1) you weren't focusing on being part of your team, and 2) you aren't taking responsibility for your own actions.

You didn't want to work below your skill level; you think 3 months is a long time and that you'd shown you could be trusted. You have also argued that you were right to do what you did.

If you were right, why don't they want you back? Could it be because you decided that it was more important to you to do every bit of work you felt you were capable of doing, than it was to get along with the other staff and not overstep your bounds?

You don't have to answer this on the forum, but you might want to consider: how many of your former co-workers were willing to talk to personnel on your behalf, and/or how many are willing to give you a reference for a new job?

If the answers are zero and zero, the day will come, eventually, when you look back and realize you have nobody to blame but yourself, and that what you did was to exhibit poor judgment.

Trying to justify it by splitting hairs doesn't change the situation.

 

[EMS49393]

I know it's tough to lose your job, and I have seen a lot of really great comments in this long argument.

In the end, though, I think you are really missing a couple of the most important points: 1) you weren't focusing on being part of your team, and 2) you aren't taking responsibility for your own actions.

You didn't want to work below your skill level; you think 3 months is a long time and that you'd shown you could be trusted. You have also argued that you were right to do what you did.

If you were right, why don't they want you back? Could it be because you decided that it was more important to you to do every bit of work you felt you were capable of doing, than it was to get along with the other staff and not overstep your bounds?

You don't have to answer this on the forum, but you might want to consider: how many of your former co-workers were willing to talk to personnel on your behalf, and/or how many are willing to give you a reference for a new job?

If the answers are zero and zero, the day will come, eventually, when you look back and realize you have nobody to blame but yourself, and that what you did was to exhibit poor judgment.

Trying to justify it by splitting hairs doesn't change the situation.

Where is the clapping hands icon? That is undoubtedly the best post within an EMS forum that I have come across in weeks, perhaps months. Nice summary.

 

[Jeremy89]

I know it's tough to lose your job, and I have seen a lot of really great comments in this long argument.

In the end, though, I think you are really missing a couple of the most important points: 1) you weren't focusing on being part of your team, and 2) you aren't taking responsibility for your own actions.

You didn't want to work below your skill level; you think 3 months is a long time and that you'd shown you could be trusted. You have also argued that you were right to do what you did.

If you were right, why don't they want you back? Could it be because you decided that it was more important to you to do every bit of work you felt you were capable of doing, than it was to get along with the other staff and not overstep your bounds?

You don't have to answer this on the forum, but you might want to consider: how many of your former co-workers were willing to talk to personnel on your behalf, and/or how many are willing to give you a reference for a new job?

If the answers are zero and zero, the day will come, eventually, when you look back and realize you have nobody to blame but yourself, and that what you did was to exhibit poor judgment.

Trying to justify it by splitting hairs doesn't change the situation.

How was I not being part of the team? I wasn't just going to leave a pt lying in bed with a 2nd degree AV block and I wanted to make sure the primary nurse knew he was in there.

Like I mentioned before, I didn't need a nurse's delegation to draw the blood, but typically we communicate with the nurses to get the blood so the pt doesn't get poked more than once. I heard the MD loud and clear (though I wasn't allowed to take a verbal order- I would have checked the computer to be sure) that they needed stat labs sent on him.

There is no harm in looking for veins, especially if the nurse would've let me start the line- I woulda been 2 steps ahead already.

As to references, the day I got fired I told a few of the RN's I was working with. I got at least 6 that told me I could contact them for references or if I needed anything just that day- more by email later. I discussed the problems I was having with that particular nurse. One of the other nurses said "I love him outside of work, but here I can't stand him" and I know other nurses felt the same way. Just a testament to his character at the workplace.

 

[Veneficus]

How was I not being part of the team? I wasn't just going to leave a pt lying in bed with a 2nd degree AV block and I wanted to make sure the primary nurse knew he was in there.

Like I mentioned before, I didn't need a nurse's delegation to draw the blood, but typically we communicate with the nurses to get the blood so the pt doesn't get poked more than once. I heard the MD loud and clear (though I wasn't allowed to take a verbal order- I would have checked the computer to be sure) that they needed stat labs sent on him.

There is no harm in looking for veins, especially if the nurse would've let me start the line- I woulda been 2 steps ahead already.

As to references, the day I got fired I told a few of the RN's I was working with. I got at least 6 that told me I could contact them for references or if I needed anything just that day- more by email later. I discussed the problems I was having with that particular nurse. One of the other nurses said "I love him outside of work, but here I can't stand him" and I know other nurses felt the same way. Just a testament to his character at the workplace.

Autonomy without responsibility or liability.

...The dream of healthcare providers everywhere.

I am very entertained by this story, it keeps getting better and better.

 

[medicRob]

I have watched this thread and have held my tongue, but as a Registered Nurse, I feel it necessary to weigh in.


It is YOUR responsibility to know your scope of practice. You were already in trouble, don't try to blame everyone else for your actions. We see it here all the time on this forum, people come in with, "I hate my Partner" or "My Job sucks" when it is usually the individual in question that is the issue, but instead of looking at their own actions and asking if they are perhaps the problem, they choose to blame someone else.

When an MD orders something in an ER setting, it is up to the RN or another physician to delegate who does what. If the MD did not tell you specifically to start an IV, you wait until you are told or you ask someone if they would like you to start it. It seems to me like you were just itching to stick somebody, so instead of asking the RN (WHO YOU KNEW WOULD TELL YOU "NO"), you went ahead and "prepped" the patient. YOU ARE AT FAULT.

Also, your comment about, "As a nursing major, I couldn't stand working as a "dumbed down" tech who wasn't allowed to share and utilize what I knew."

Nursing major doesnt mean $h!t if you are working in the capacity of a tech. You are under the delusion that you being a nursing student actually means something with regard to your scope of practice. Son, you are not an RN until you take the NCLEX and you get your license. Don't get it twisted.

Don't start with the, "When Im on clinicals" BS either. The fact is at the time you were in the capacity as an "ER Tech", not an RN Student. I am a Nurse Practitioner student, but do you think I am going to try to write a prescription for my patient without a certificate of fitness?

I see your type in my practice every day. You think that because you are a nursing student that you are somehow better than the average tech or that you are magically given an extended scope of practice. Even when you finish your RN license, you are going to be under an RN for a year while being trained.

Bottom Line:

You were warned, you didn't listen. You got fired, and you deserved to be fired.

If you were a nursing student on clinical rotations with me in the trauma unit or the ICU, I would fail you for the day for that crap.

/Thread

 

[Shishkabob]

Which brings up the whole BoN pushing their weight around to get things enacted that make THEM the only ones seen as "licensed" practitioners in the hospital setting when compared to other health professionals like Paramedics....

 

[medicRob]

Which brings up the whole BoN pushing their weight around to get things enacted that make THEM the only ones seen as "licensed" practitioners in the hospital setting when compared to other health professionals like Paramedics....

I wasn't necessarily speaking about Paramedics Linuss. I was thinking more along the lines of a CNA working as an ER Tech, or in this guy's case an EMT-B.