Working EMS plus nursing ?

[VFlutter]

How many times a shift are you carrying a 300lb patient down a flight of stairs or lifting someone non-weight bearing? How many sets of hands do you usually have on a scene?

I was extremely lucky that I had ceiling lifts in all my ICU rooms however I had many colleges suffer career ending back injuries at work. Most nurses have to turn and lift totally non weight bearing patients multiple times a hour, every hour for 12hrs straight, every day. It's the repetitive stress that causes most of these injuries. And despite what you may think there is rarely much extra help. And when you have that poor patient that is a total lift to the chair that needs to go to the bathroom every 15mins and every one else is busy you end up hurting yourself.


I'm not arguing EMS isn't just as physically demanding and has frequent injuries as well as worse insurance and benefits but to say that nursing is only occasionally physical with just passing meds and wheeling around a computer is a little ignorant.

 

[hometownmedic5]

The weight varies, but I carry patients either with the chair or on the stretcher every single shift, usually more than once. Sometimes I have adequate help, sometimes I have the time to wait for additional help, sometimes I do not and sometimes the "help" I get is more trouble than it's worth.

There are time critical moves and there are non time critical moves. While it might be awkward or embarrassing, a patient can mess themselves before I'll break my back to get them to the toilet alone. My back comes before your pride. That patient can wait until more help is available in the hospital, unless they will die or suffer grievous bodily harm before help can arrive. A poorly located bowel movement is not life threatening.

My point is that the system isn't responsible for your failure to protect yourself during non critical moments. If you can't safely tend to your patient alone and they aren't going to die between now and when you can get help, then wait for help and reduce the injury rate.

 

[Summit]

@hometownmedic5 take it from those of us who have done both, your simplistic dismissals and victim blaming are way off the mark.

I just don't get why you seem to think that nothing is time sensitive in nursing and must be the nurse's fault, not a systems issue, but it is not your fault if you work for an employer where you feel there is a systems issue that prevents reporting of injuries.

Also, I don't know why you think that RNs have a higher percentage of union representation than medics... most work for private sector employers while an ever increasing number of medics are IAFF, plenty are government, not to mention the privates with union. There are a whopping 2 hospitals in my state with unionized nurses... both are federal hospitals. There are tons of Fire/EMS services though.

 

[EpiEMS]

For what it's worth, some data...latest Bureau of Labor Statistics (of the U.S. Department of Labor) that I could find were 2015.

EMTs and Paramedics (yes, they group us),
313.5 non-fatal occupational illnesses injuries involving time away from work per 10,000 workers versus 118.6 for registered nurses.

Just an interesting point. (There is lots of very detailed data if folks care to look at it.)

 

[Summit]

For what it's worth, some data...latest Bureau of Labor Statistics (of the U.S. Department of Labor) that I could find were 2015.

EMTs and Paramedics (yes, they group us),
313.5 non-fatal occupational illnesses injuries involving time away from work per 10,000 workers versus 118.6 for registered nurses.

Just an interesting point. (There is lots of very detailed data if folks care to look at it.)

Very interesting point... I'll try to find the article with stats I was referencing. (I am recalling it was back injuries specifically now that I think about it).

But hey, your BLS stats are just made up phooey according to hometown

 

[EpiEMS]

Very interesting point... I'll try to find the article with stats I was referencing. (I am recalling it was back injuries specifically now that I think about it).

Back injury figures are actually available from the BLS!

EMTs & Paramedics: 104.8 non-fatal back injuries requiring time off per 10,000 workers and 95.0 non-fatal overexertion injuries requiring time off involving lifting per 10,000 workers

RNs: 32.1 per 10,000 for back injuries and 10.3 per 10,000 for lifting

Caveat -- these involve *time off*.

I think the figures for some professions are probably understated, particularly for those that are paid hourly and where labor supply is high.

BTW: my data is coming from https://data.bls.gov/gqt/InitialPage --> drill down to produce tables.

 

[Summit]

Back injury figures are actually available from the BLS!

EMTs & Paramedics: 104.8 non-fatal back injuries requiring time off per 10,000 workers and 95.0 non-fatal overexertion injuries requiring time off involving lifting per 10,000 workers

RNs: 32.1 per 10,000 for back injuries and 10.3 per 10,000 for lifting

Caveat -- these involve *time off*.

I think the figures for some professions are probably understated, particularly for those that are paid hourly and where labor supply is high.

BTW: my data is coming from https://data.bls.gov/gqt/InitialPage --> drill down to produce tables.

Yep, I was just perusing https://www.bls.gov/news.release/pdf/osh2.pdf although that gives more like 50 not 32 for musculoskeletal

I can't find the article I was referring to (it was posted up on an education board a few years back).

It is worth noting that less than 60% of RNs are bedside nurses, so you have all the management, research, admin, quality, IC, school, HH and other nonphysical types included in there. Whereas I'd wager EMS personnel are 95% direct patient care. Still doesn't make up the gap. Wish I could break it down by area of RN specialty and peep at ICU and med surg numbers. Now if you look at CNAs, they are about the same as EMS.

Although I find it interesting that injury rates for CNAs are down by 15% over the last 3 years! More places are putting in lifts or getting serious about injury prevention. It was that way at all the facilities I was at. When I was 911 they were serious too and FD never objected to a lift assist. SAR... it's not that people aren't serious, but dang there is only so much you can do. I'd also love to see ski patrol numbers... bet they are sky high.

 

[EpiEMS]

@Summit, that's a great reference doc - I like it better than the tables for looking at point-in-time data for sure.

I would expect that CNAs have similar rates as EMS, but I would be curious what the trend down is related to -- substituting manual lifting for mechanical devices, say? I would also emphasize that it seems likely to me that mechanical lifting devices seem to be more practical in the fixed facility setting.

 

[Summit]

@Summit, that's a great reference doc - I like it better than the tables for looking at point-in-time data for sure.

I would expect that CNAs have similar rates as EMS, but I would be curious what the trend down is related to -- substituting manual lifting for mechanical devices, say? I would also emphasize that it seems likely to me that mechanical lifting devices seem to be more practical in the fixed facility setting.

I think employers are realizing they can save more money by not having the staff out on injury and paying work comp than it costs to provide safety tools and programs like lift teams, although the number one is sufficient staffing and staffing ratios which the green eye shade folks always fight.

Probably fair comparison CNA to EMS. I'd bet that ICU RNs have the same rates as CNAs and EMS as well since ICU RNs typically do total care and don't have CNAs.

In general yes lifts are better for facilities than the field, though there are portable lifts (however you aren't going to carry them up stairs).
However, even in a facility there are so many times when you just can't use a lift effectively like some dressing changes, procedures, or hygiene. They really work for re-positioning or moving, but that is only half the battle.

 

[EpiEMS]

@Summit, that's some very interesting context. I'd be curious about the ICU, too - parallels like that are awfully helpful if we can find the data.

I think the overall point here is that lifting from patient care results in a significant injury burden to providers, regardless of field.

 

[hometownmedic5]

@hometownmedic5 take it from those of us who have done both, your simplistic dismissals and victim blaming are way off the mark.

I just don't get why you seem to think that nothing is time sensitive in nursing and must be the nurse's fault, not a systems issue, but it is not your fault if you work for an employer where you feel there is a systems issue that prevents reporting of injuries.

Also, I don't know why you think that RNs have a higher percentage of union representation than medics... most work for private sector employers while an ever increasing number of medics are IAFF, plenty are government, not to mention the privates with union. There are a whopping 2 hospitals in my state with unionized nurses... both are federal hospitals. There are tons of Fire/EMS services though.

Some of these topic of conversation become a difference of location. Here, very few private service ems workers are union, while the overwhelming majority of nurses are represented. It would seem your situation is the opposite.

Nowhere did I say nothing in nursing is time sensitive. What I said is that there are time sensitive moves and non time sensitive moves and a patients bowels don't keep the clock. A poop can wait for help, or to be cleaned up. A repositioning can wait. Maybe not hours and hours, but ten minutes until another staff member finishes XYZ shouldn't be a problem. A patient in acute respiratory distress probably cant wait for another ambulance or an engine coming from across town, nor can a patient in the hospital who boxes in the bathroom, but that wasn't the example you decided to use. You want with bowel movements and pressure sores, so that's what I'm responding too.

I'm not willing to sacrifice my health for non emergent risks. The fact that these nurses you are defending aren't capable of making the same decision isn't my fault.

 

[Summit]

You want with bowel movements and pressure sores, so that's what I'm responding too.

I'm not willing to sacrifice my health for non emergent risks. The fact that these nurses you are defending aren't capable of making the same decision isn't my fault.

Ya. You got not clue what it is like to be a nurse, so this discussion isn't worth continuing. But I will say that it is hilarious you are so judgmental about workplace pressure induced hazardous actions yet are moaning about the lack of union protection in EMS... because by your standard, any negative outcomes for you due to your employer's attitude is entirely your fault because you are capable of making a decision to quit.

 

[EpiEMS]

Yep, I was just perusing https://www.bls.gov/news.release/pdf/osh2.pdf although that gives more like 50 not 32 for musculoskeletal

Interestingly, the data tables that I was able to generate from their database gives injury by location, so I just abstracted back as an example.

Maybe not hours and hours, but ten minutes until another staff member finishes XYZ shouldn't be a problem.

As a provider, you can do that -- unless your management makes your life difficult. As a manager, there's tough cost/benefit calculus.

You got not clue what it is like to be a nurse

(Not that this was directed to me, I don't think I myself could handle it! More than 20 minutes with a patient is like torrrrrture.)

 

[Akulahawk]

The weight varies, but I carry patients either with the chair or on the stretcher every single shift, usually more than once. Sometimes I have adequate help, sometimes I have the time to wait for additional help, sometimes I do not and sometimes the "help" I get is more trouble than it's worth.

There are time critical moves and there are non time critical moves. While it might be awkward or embarrassing, a patient can mess themselves before I'll break my back to get them to the toilet alone. My back comes before your pride. That patient can wait until more help is available in the hospital, unless they will die or suffer grievous bodily harm before help can arrive. A poorly located bowel movement is not life threatening.

My point is that the system isn't responsible for your failure to protect yourself during non critical moments. If you can't safely tend to your patient alone and they aren't going to die between now and when you can get help, then wait for help and reduce the injury rate.

I would generally expect that you don't do your job solo and don't carry patients around by yourself using the chair or the stretcher all by your lonesome. What's nice in EMS is that your ratio of help to patient is 2:1. In the hospital, often the best we can do is 1:1 for total care patients and there are some care activities that you just can't use mechanical lifts and aids for. I'm an ER nurse and often I don't have assistance available, though I usually can wait or arrange for another nurse or one of our techs to help with moving a patient. Things really get interesting when you have 4 patients and all of them need to be assisted with something physical pretty much all the time. Yes, my ratio is usually 1:4 and sometimes I have to care for 2-3 total cares and the ER doesn't have a lift immediately available. There might be one down in Med/Surg...

It's not all about bowels, bedsores, and wiping butts. The (larger) problem is fall prevention and workplace injury prevention. Good luck when your patients insist on being mobile when they really shouldn't and restraining them physically or chemically isn't a legal option...