To Take or not to Take?

[WTEngel]

A somewhat related question, since a couple of people mentioned it. How many sets of vital signs do you generally take?

I usually do q 10 vitals for stable patients. It may not be necessary, but it makes it look like you are earning your money in the eyes of the patient.

I try to set my LP to do q 5 vitals on critical and unstable patients. Sometimes this is hard to do with all of the other interventions, but it will help a lot on the code summary and writing the report.

I also try to take vitals after any medical or procedural intervention.

 

[Too Old To Work]

I must be reading this wrong. It comes across very bitter, angry and very much like you are not a part of a patient care team, but an entity all your own.

We're part of a health care team, just not your health care team. We have our own set of responsibilities which keep us busy. If you want to see bitter and angry, walk down to your ER and talk to the nurses. That's a pretty angry group.

As a hospital administrator I can tell you that the way you are portraying yourself is NOT a part of a solution, but a part of a problem. It may sound cliche or idealistic but EMS is all part of the patients line of care, and we should work together.

Nice in theory, but again YOUR nurses don't seem to be on board with that. They treat the EMTs like crap, mainly because they are younger and less experienced than the medics as a rule. They can't get away with it as much with the medics, who are generally older and more experienced. I know that a number of hospitals that I transport to are aware of the problems and have put the nurses on notice.

We also see how nurses at various hospitals treat patients. That comes under the general heading of "Would I want my family member treated here?" and the answer is often no.

The advantage that I have over you is that I'm in a number of hospitals each shift. I can compare and contrast, which you can't do.

You want to improve the team? Get the nurses on board and tell them to be nice to the patients and EMS.

But, like I said. I am only reading a two dimensional post and I am sure you are nothing like you came across.

Just call me Flat Stanley.

 

[medicdan]

We're part of a health care team, just not your health care team. We have our own set of responsibilities which keep us busy. If you want to see bitter and angry, walk down to your ER and talk to the nurses. That's a pretty angry group.



Nice in theory, but again YOUR nurses don't seem to be on board with that. They treat the EMTs like crap, mainly because they are younger and less experienced than the medics as a rule. They can't get away with it as much with the medics, who are generally older and more experienced. I know that a number of hospitals that I transport to are aware of the problems and have put the nurses on notice.

We also see how nurses at various hospitals treat patients. That comes under the general heading of "Would I want my family member treated here?" and the answer is often no.

The advantage that I have over you is that I'm in a number of hospitals each shift. I can compare and contrast, which you can't do.

You want to improve the team? Get the nurses on board and tell them to be nice to the patients and EMS.



Just call me Flat Stanley.

I believe we work in the same jungle gym, and nurses have come to expect that we will get the vitals. It's just become habit for me to get them if I drove, while my partner gives the report, or helps the nurse navigate the screens. I usually write them on a 3x5 card and hand them to the nurse or my partner with TRIAGE VITALS written at the top. The only thing I won't do is a BAC, and that's because I have a terrible history of breaking those dang machines. We are a healthcare team, and if I can make the nurse's job easier without much effort, I'll go for it.

 

[Shishkabob]

I'm with Flat Stanley


Too many times nurses have questioned why I wanted a piece of information when taking a patient from them. One yesterday questioned why I wanted the patients history, meds, and allergies....as of I wasn't a continuum of patient care.


When I transported a sexual assault patient a few weeks back and asked for pertinent info, another nurse said "Don't tell them anything....we have to minimize the amount of leakage of info. "....


I asked the nurse if she'd rather me plop a patient on her bed and walk away without giving her a report, them proceed to ignore her protest when I got the report from another nurse.


It baffles me that, a lot of the time, nurses don't do the same things to help us that they expect us to do for them. Vitals, moving the patient to the bed without asking, giving a patient report to the provider receiving the patient....basic things we all do.


Granted, many nurses do, and they are the ones I'll help, but I'm not helping those who won't be bothered to help me.

 

[WTEngel]

I think the easiest thing to do would be address the problem directly and respectfully.

It seems that it is not the fact that she asked you (or ordered you, however you look at it) that bothers you, it is how she did it.

If you feel she was being disrespectful when she requested you take the vitals, respectfully tell her. Maybe she was having a bad day, maybe it is just the way she is, but if she continues to be disrespectful, then you can always escalate the problem to her supervisor and so on...but the supervisor is not likely to take any action if you haven't first tried to addres the problem at your level.

Nobody deserves to be spoken to disrespectfully, RN, EMT, or Paramedic...open communication will likely solve the problem. As always, there is a time and a place to deal with such things, and in front of the patient is not when or where. So you did the right thing by not making a scene. That doesn't mean you can't approach her later and ask her about it...

 

[Too Old To Work]

I think the easiest thing to do would be address the problem directly and respectfully.

It seems that it is not the fact that she asked you (or ordered you, however you look at it) that bothers you, it is how she did it.

If it were one nurse, I wouldn't care, I'd just ignore her. It's become institutionalized at a number of hospitals. It's not like it's going to speed up the triage process. Which takes about the same amount of time that it takes a diamond to form under the earth.

 

[WTEngel]

Fair enough...then you have two choices:

1.) Take a stand. Hold your ground, prove your point and no longer take the vitals. Maybe they only push you around because they can...

2.) Kill them with kindness. Treat them better than you would like to be treated...

In the end, if it were me, I would kill them with kindness. It doesn't take that much out of my day, and in the end, I am a happier person. I can take comfort in the fact that they are probably more miserable because they have a less fun job...besides, if they treat their patients like they say you do, then your care will stand out as the best part of that patients day.

Eventually they will turn their act around...

 

[Too Old To Work]

Fair enough...then you have two choices:

1.) Take a stand. Hold your ground, prove your point and no longer take the vitals. Maybe they only push you around because they can...

:lol:

Slight correction. They only try to push me around because they think they can.

 

[Aidey]

Here's a completely meaningless post for discussion.

You bring a patient (non acute) into one your local EDs. You give report to the traige nurse. Said nurse asks if you got vital signs. You say you did, the ones that you just reported. No, she means did you get vital signs at triage for her to put in her report.

So, is this our responsibility?

This makes no sense to me since ER patients are triaged in their room by the nurse we are giving report to. There is no place to stop an get vitals after we get to the ER. If you are talking about helping the RN get the pt undressed, into a gown, and hooked up to the monitors, yes, we will sometimes help if they need it. There are a number of docs I work with that like getting report directly, so if I'm standing around in the room waiting for him I may as well help if they need it.

 

[the_negro_puppy]

A somewhat related question, since a couple of people mentioned it. How many sets of vital signs do you generally take?

All depends on the job and pt.

If its a mild abdo pain with a short transport - lets saying 30 mins from arrival at house to arrival at hospital i might do 3 or so.


If its a sick pt maybe every 5. Or if im giving drugs GTn, morphine etc obivously will be doing a quick bp etc before giving

 

[MusicMedic]

I dont mind taking a set of vitals in the ER, i actually like hooking them up to the monitor, gives me something to do while standing around in the ER.. and i find it quite... entertaining!! (seriously!!)

 

[WTEngel]

This makes no sense to me since ER patients are triaged in their room by the nurse we are giving report to. There is no place to stop an get vitals after we get to the ER. If you are talking about helping the RN get the pt undressed, into a gown, and hooked up to the monitors, yes, we will sometimes help if they need it. There are a number of docs I work with that like getting report directly, so if I'm standing around in the room waiting for him I may as well help if they need it.

Most busier ERs have a triage station that you are supposed to bring your stable patients to so the triage nurse can assign them a room. At the triage station they will take a set of vitals, get the history, do an initial assessment, etc.

Some facilities will send you directly to a room, but from where I am from that is generally a luxury, as most of the time the ER bed space is at a premium.

 

[JPINFV]

That's highly dependent on location. I can think of 1 hospital in the Greater Orange County (CA) area that does that, and everyone hates that hospital (PIH) because it normally takes 2-3 hours to drop off a patient.

 

[Aidey]

Most busier ERs have a triage station that you are supposed to bring your stable patients to so the triage nurse can assign them a room. At the triage station they will take a set of vitals, get the history, do an initial assessment, etc.

Some facilities will send you directly to a room, but from where I am from that is generally a luxury, as most of the time the ER bed space is at a premium.

When we have triage appropraite patients we wheel them (or walk them) out to the waiting room, have them take a seat, and then fill out one of the intake slips for them. I usually give a 30 second report to an RN and that is the end of our involvement.

 

[mcdonl]

We're part of a health care team, just not your health care team. We have our own set of responsibilities which keep us busy. If you want to see bitter and angry, walk down to your ER and talk to the nurses. That's a pretty angry group.

Nice in theory, but again YOUR nurses don't seem to be on board with that. They treat the EMTs like crap, mainly because they are younger and less experienced than the medics as a rule. They can't get away with it as much with the medics, who are generally older and more experienced. I know that a number of hospitals that I transport to are aware of the problems and have put the nurses on notice.

We also see how nurses at various hospitals treat patients. That comes under the general heading of "Would I want my family member treated here?" and the answer is often no.

The advantage that I have over you is that I'm in a number of hospitals each shift. I can compare and contrast, which you can't do.

You want to improve the team? Get the nurses on board and tell them to be nice to the patients and EMS.

Just call me Flat Stanley.

Stan, first I agree with everything you say with the exception of perpetuating the problem by taking a stance of yours and mine. The patients are ours. The responsibility of pre-hospital care belongs to EMS and hospital care to the Hospital.

The transfer is the gray area that is clearly handled many different ways by many different services/hospitals. I give my report, hook the patient up while the nurse interviews the patient and then get assigned a room number where we take the patient to the room and the patients nurse works with use to transfer the patient to the bed, and we leave. This requires team work.

Nurses in the ER have their own issues and complications. I am not ignorant of the perceived pecking orders that exist. Sadly, it goes all the way from the Basic, through Medic, RN up through MD's and even continuing onto the surgeon level.

But, the hierarchy is in place to provide appropriate scopes of service not to place one person higher in importance than another.

Also, even though I work in a hospital full time I also transport as an EMT to six different hospitals so I have the unique view of an EMS provider and a hospital program manager.

So, MR. Flats... you may not be better than the RN's who are disrespecting you but you are better than their behavior and you can use that to your advantage. If a nurse pushes the issue, remind them that assessing the patient and collecting vital signs is part of the care of the patient, and cannot be done with ED equipment until the official transfer has taken place, and that you have no jurisdiction to provide patient care in the hospital.

Unless they want to be nice, and say please and thank you.

 

[Too Old To Work]

The transfer is the gray area that is clearly handled many different ways by many different services/hospitals. I give my report, hook the patient up while the nurse interviews the patient and then get assigned a room number where we take the patient to the room and the patients nurse works with use to transfer the patient to the bed, and we leave. This requires team work.

Transfer isn't all that gray. CMS has clear cut rules about when the patient becomes totally the responsibility of the hospital. What surprises me is that there isn't more litigation and fines leveled at hospitals and individual nurses over this issue.

Nurses in the ER have their own issues and complications. I am not ignorant of the perceived pecking orders that exist. Sadly, it goes all the way from the Basic, through Medic, RN up through MD's and even continuing onto the surgeon level.

Surgeons AND MDs!

But, the hierarchy is in place to provide appropriate scopes of service not to place one person higher in importance than another.

Intent does not equal actuality.

So, MR. Flats... you may not be better than the RN's who are disrespecting you but you are better than their behavior and you can use that to your advantage. If a nurse pushes the issue, remind them that assessing the patient and collecting vital signs is part of the care of the patient, and cannot be done with ED equipment until the official transfer has taken place, and that you have no jurisdiction to provide patient care in the hospital.

Unless they want to be nice, and say please and thank you.

I have been known to tell them that I can't use their equipment because JCAHO requires that all staff using patient care equipment show competency on that equipment. Since I transport to so many hospitals and each seems to have a different brand and model of equipment, I'd be more than happy to help them out provided they give me four hours of in service training at my overtime rate.

For some reason, they seem to respond with a lot of this,

Can we at least agree that I'm better than the residents? Work with me here.

 

[mcdonl]

Can we at least agree that I'm better than the residents? Work with me here.

Your killing me slim!!

You know what I was saying, we are all people and none of us are any better then the next guy just have a different Scope of Service.

But... ok... maybe a few of the residents!

While we are on the subject, why do they not teach the operation of buckles are in med school. They clearly taught the use of trauma shears, and I am almost certain they are told specifically to CUT all straps securing a patient to a backboard.

 

[jjesusfreak01]

They clearly taught the use of trauma shears, and I am almost certain they are told specifically to CUT all straps securing a patient to a backboard.

Well thats stupid. Thats almost as bad as docs cutting through mast pants.

 

[CAOX3]

Its called professional courtesy, if they're slammed I dont have a problem getting a BP for them. I am under the impression that its my patient anyway until a report is given then again we dont have the "us vs them" mentality more like we're in this mess together.

Remember they know where the donuts are.

 

[Too Old To Work]

Well thats stupid. Thats almost as bad as docs cutting through mast pants.

Mast pants? Does anyone still use those things?