Working with Nurses

[EFDUnit823]

So, I don’t want to start a whole EMS (EMT) vs. Nursing argument, but do want to get some input about this subject from others.

My job has me working in an Emergency Department alongside nurses when not on the ambulance. Many nurses I work with respect EMS personnel, however, it seems more so want to consider us equivalent to CNAs. This even goes beyond “feelings” as many to work to limit EMS practice in the ED e.g. nurses only triage/patient assessment, etc… A constant battle regardless of level (EMT-B/I/P)!

So, is there anyone else out there who work in EDs when not on the ambulance, and if so, do you experience the same? What are some “creative” ways you use to mess with these nurses? Why do you think there is such a lack of respect for EMS amongst Nursing? Just curious…

 

[mgr22]

Nurses don't necessarily know what paramedics can and can't do. As a student, you're supposed to be learning about that, too. If you concentrate on doing the best job you can, and show that you don't mind getting your hands dirty, you'll probably gain some respect.

 

[Bullets]

When you get down to the foundation of EMS, triage is what we do. We handle patients every day and our whole assesment is oriented towards steering our patients towards the proper care. ALS.or BLS, red yellow green white black, trauma code STEMI stroke, near or far. It's all triage, so when you have ems in a hospital, put them in the area they do best. EMS is far more mentally oriented towards rapid triage then a nurse. It's not a good or bad thing, just different education for different needs. Our PCA (CNA) at my local hospital prefers hiring EMTs and supplementing their education with hospital specific education

 

[Pneumothorax]

Some nurses may simply be Lacking knowledge of what EMS really is. Some don't care, some are just bitter humans that no matter what will treat anyone like crap regardless who it is.

 

[usalsfyre]

It's about playing in other's sandboxes. If hospitals could hire EMT-Ps for the ED instead of RNs they would, it would be considerably cheaper. Therefore nursing seeks to limit the role of non-RNs. Perfectly reasonable.

This is why I (and all of us should) oppose PHRNs, RN to EMT-P bridges, ect. Want to come play in our sandbox? Get the full education.

 

[Shishkabob]

Get some higher ups in your hospital to require ED nurses to do ambulance rides... even if it's just one 'orientation ride' a year.

 

[Medic Tim]

I used to work for a hospital based service. They required all er nurses to do at least 2 or 3 als calls with us during orientation. We also had orientation in the er. Whenever a code was called or poop hit the fan they would call us over to help them out.

 

[saskgirl]

I guess our serivice is pretty lucky as we work very well with our nursing department. We are based out of the hospital but don't work on the floor with the nurses unless they call us in.
We have great support from our head nurses. There is the odd RN or LPN that looks down on us like we are scum but I personally just ignore it and do my job. I know what their job is when an emergency comes in and I know what my job is and we all know that when we work together things go alot better.
Respect is a huge part of this, we respect them and what they do and in return we get respect. It's not us against them its a co-worker relationship.

 

[mycrofft]

OP, that argument is already on. See SEARCH ("incompetent nurses"). Not to worry, it's always lively.

 

[Veneficus]

So, I don’t want to start a whole EMS (EMT) vs. Nursing argument, but do want to get some input about this subject from others.

My job has me working in an Emergency Department alongside nurses when not on the ambulance. Many nurses I work with respect EMS personnel, however, it seems more so want to consider us equivalent to CNAs. This even goes beyond “feelings” as many to work to limit EMS practice in the ED e.g. nurses only triage/patient assessment, etc… A constant battle regardless of level (EMT-B/I/P)!

So, is there anyone else out there who work in EDs when not on the ambulance, and if so, do you experience the same? What are some “creative” ways you use to mess with these nurses? Why do you think there is such a lack of respect for EMS amongst Nursing? Just curious…

I worked along side nurses for 4 years of my paramedic career in a hospital.

Many of the older nurses realized that nurses and medics serve seperate functions.

The major issues were with the newer ones.

Apparently they were taught that any non-physician, non-nurse provider was an "ancillary" provider that nurses had to oversee.

The solution I found was rather simple. I did the best I could at everything I was asked to do. After a few months of that, I was "protected" by the older nurses. Particularly the charge nurses who knew I didn't have to be told what to do, if I saw something needing done, I did it. They also knew that when I said I would take care of something, they never had to worry about it again.

I was never once asked to do "nursing" things like change a patient or help one to the bathroom, etc. But I took it upon myself to "assist" when a nurse looked like they needed help.

It doesn't take them long to discover to discover that if somebody lets me do my thing, i can generally exceed what can be expected.

 

[Level1pedstech]

In most cases freedom and scope of practice in the ER is more about gaining the respect and trust of the ER staff and less about being allowed to do things even if you think its something that falls within your scope of practice out in the field. Most emergency departments could give a rats butt how much training you have or how many certifications you have managed to earn. To us your a snot nose rookie and will hold such status until you prove yourself it does not matter if your a basic or a CCT medic, we know that EMT's of all levels are a dime a dozen and have seen many float through the ED over the years. Some turn out to become valuable members of the team but most just move on down the road all butt hurt that they just could not make those horrible ER hardened nurses see that they are their equal god its so unfair.

Hospitals extend practice priviledges based on knowledge,ability and showing that you can be trusted to perform advanced procedures. In most emergency departments triaging is considered an RN skill, you may triage in the field but that does not make you qualified to do it in the ER. Hospitals are looking to reduce their liability and avoid damaging lawsuits this is why in many ER managers eyes EMT's are not qualified to triage even if your a medic. Trust me I have had this discussion with many managers over the years and it's just the way it is.

The best way to earn practice priviledges is to gain the trust and respect of the charge RN's,not by kissing up but by doing you job and not worrying about what others do. Instead of learning how to "mess with the nurses" why not step it up and show that your deserving of more advanced duties by jumping in and showing that to you nothing is below your pay grade. The same RN you help with that code brown might latter be the one that asks for you to assist on an advanced procedure. Over the years I have done things in the ER that were far above my EMT-I scope of practice and it was because I had the trust and respect of the entire team.

Charge nurses will make you or break you and because they run the ER and watch everything that goes on you need to learn to be a stand out member of the team and not a trouble maker. The ER staff can sniff out a tool and will deal with that person accordingly including giving you the label EMT/CNA even when they damn sure know the difference.

 

[johnrsemt]

When I was in the ED first as a student; then as a paramedic: I would do everything I could:

I would stock rooms, (even when the is a stock person) when there is 100 rooms, or 20 rooms; they need help stocking. I would replace linens; dump the full linen bags, dump the trash etc.
As a student; go in, introduce yourself to the charge nurse; and trauma/shock room nurses: then go through room checks with the trauma room nurse; don't ask very many questions at that point, just go through the checks. Save your questions for later when it is slow.
Then tell them that you would appreciate it if they will let you watch the good stuff; and ask them where the supply room and linen cart is; and go through their room and all the rest of the rooms stocking.
I had the trauma room nurses calling me on the PA whenever something good came in, because they knew that I would do the grunt work with them, or so they didn't have to do it.

I would do the one thing that most nurses and techs hate: I would prep dead bodies to go to the morgue: cut the IV lines, and ET tubes (Leave them in place, just cut them shorter); tape them down so they wouldn't pull loose in the bag; roll the body onto the bag, then into the body bag. then take it down on the cart, and have security meet me to help put them on that cart.

I would also help housekeeping clean up trauma rooms after something bad was done. Surprising how much helping housekeeping will score points wit the nurses.

 

[RocketMedic]

I never really cared what the nurses thought about my housekeeping skills, but I professionally let them know that I was there to learn and I'd really appreciate it if they'd teach me all they could. Worked wonders.

 

[MRSA]

I think I can agree with some of these post actually.

I've tried educating a few nurses and LVN's and found they really just don't know what we can and can't do. I always let them know as nicely as possible.

Some nurses really just don't care and think that they run the whole pony show though so there's a little bit of that too.

What I chock it down to is that you always, no matter WHAT, treat the nurses with the utmost respect even if they won't treat you the same. I know way too many mates that lost their jobs just by talking back to nurses and quite a few emts.

I'm actually looking to be an RN or LVN maybe in the distant future. I want to be that cool nurse EMTs can talk to and ask all the questions they want!

And honestly, I really think there should be an EMT-RN or EMT-LVN that specifically does the discharges for a station or two. That way that RN or LVN would know exactly what to tell these guys.

A wishful world, I think

 

[Tigger]

I rarely have a problem with nurses, be it in the ED or at an SNF. Every now again there will be a misunderstanding, but I realized when I started working that as long as I appear competent, there will not be a problem. When we get to the ER with a patient, I have my stuff in order. Same with when we're doing a pickup for dialysis. I don't bother trying to educate nursing staff about the job I do, I just do my job well and that makes their job easier. When you're efficient, the nurses could care less about you, sometimes they're even nice. Really my goal is to not be noticed, because I really just do not care how I am viewed.

I do not feel superior to nurses because let's face it, I am not. I am a basic with 160 hours of education. Even the LPN at the crappiest nursing home in the city has more "education" than I do. Obviously it's different for medics, but I have no interest in trying to impress nursing staffs. I come in, I interact with them in a pleasant manner, and then I leave. We have different jobs, there is no need to try and measure up to nursing staff. If they give you crap, don't take it personally. Just do your job.

 

[Akulahawk]

Just do your job to the best of your ability. That will impress the Nurses more than anything. So far in RN school, I have heard ZERO about what EMT and Paramedic personnel can do in the field. I might hear something about that when I get to doing my ED rotation. I fully expect that most RN's don't have much of a clue about the difference between Paramedics and EMTs beyond that there's a different title for the two. My experience doing BLS and ALS transfers over the years has led me to that conclusion.

Just by doing my job to the best of my ability has had me hearing this way too many times (when I was an EMT): "why didn't you get a [insert Paramedic-level procedure here]?" Eventually, the RNs got to know me and what I could do. I rarely was questioned about why I didn't do something (because they knew I wasn't allowed to) and my reports got things rolling much faster because they could rely on my report being accurate.

In short, I just did my job. The rest just fell into place.

As for RN (or anyone else for that matter) personnel that want to become a Paramedic by challenge, I would want any advanced non-Paramedic provider to take an EMT-B course and do the full internship/ride time (along with all required merit badges), and pass the exam in order to earn the title Paramedic.

 

[jjesusfreak01]

Just do your job to the best of your ability. That will impress the Nurses more than anything. So far in RN school, I have heard ZERO about what EMT and Paramedic personnel can do in the field. I might hear something about that when I get to doing my ED rotation. I fully expect that most RN's don't have much of a clue about the difference between Paramedics and EMTs beyond that there's a different title for the two. My experience doing BLS and ALS transfers over the years has led me to that conclusion.

Just talked to a friend in nursing school the other day. I had mentioned something about some medication (lets say Benadryl) and when I might give it IV. The nurse was surprised and unaware that Intermediates are allowed to give IV medications, even though she was familiar with the certification.

 

[Akulahawk]

Just talked to a friend in nursing school the other day. I had mentioned something about some medication (lets say Benadryl) and when I might give it IV. The nurse was surprised and unaware that Intermediates are allowed to give IV medications, even though she was familiar with the certification.

That's exactly what I mean. They may know the titles but may not have much of a clue about what each level can do. Pre-hospital personnel aren't Nursing personnel and don't fall under the typical delegation scheme that Nursing has, and normally EMS types don't work as an EMS designation where Nurses work. It's not at all surprising to me that Nurses don't know the scope for each level of EMS provider.

 

[EFDUnit823]

In most cases freedom and scope of practice in the ER is more about gaining the respect and trust of the ER staff and less about being allowed to do things even if you think its something that falls within your scope of practice out in the field. Most emergency departments could give a rats butt how much training you have or how many certifications you have managed to earn. To us your a snot nose rookie and will hold such status until you prove yourself it does not matter if your a basic or a CCT medic, we know that EMT's of all levels are a dime a dozen and have seen many float through the ED over the years. Some turn out to become valuable members of the team but most just move on down the road all butt hurt that they just could not make those horrible ER hardened nurses see that they are their equal god its so unfair.

Hospitals extend practice priviledges based on knowledge,ability and showing that you can be trusted to perform advanced procedures. In most emergency departments triaging is considered an RN skill, you may triage in the field but that does not make you qualified to do it in the ER. Hospitals are looking to reduce their liability and avoid damaging lawsuits this is why in many ER managers eyes EMT's are not qualified to triage even if your a medic. Trust me I have had this discussion with many managers over the years and it's just the way it is.

The best way to earn practice priviledges is to gain the trust and respect of the charge RN's,not by kissing up but by doing you job and not worrying about what others do. Instead of learning how to "mess with the nurses" why not step it up and show that your deserving of more advanced duties by jumping in and showing that to you nothing is below your pay grade. The same RN you help with that code brown might latter be the one that asks for you to assist on an advanced procedure. Over the years I have done things in the ER that were far above my EMT-I scope of practice and it was because I had the trust and respect of the entire team.

Charge nurses will make you or break you and because they run the ER and watch everything that goes on you need to learn to be a stand out member of the team and not a trouble maker. The ER staff can sniff out a tool and will deal with that person accordingly including giving you the label EMT/CNA even when they damn sure know the difference.

I hear what you are saying, and see the same here. I see nothing wrong with a person “proving themselves,” but much of it is way beyond this. The same who seem to think EMS is beneath them, seem to think they are smarter than Doctors as well. Also, it has nothing to do with work ethics on the EMS side. I do agree, it may be childish on my part to want to “mess with” these types of nurses, but in my opinion they are lost causes. It doesn’t matter how competent an EMT proves themselves to them, they will always be greater (in their mind). Plus, on more than one occasion I have witnessed this nurses screw something up and try to pawn it off on EMS.

NOTE: Understand I am not claiming all nurses act like this, just stating that many do.

 

[ExpatMedic0]

its really depends on the nurse, just like it depends on the medic. I had a second part time job a clinic for several years. The main RN in that department who was on the same shift as me became one of my best friends. Its been 6 years now and I do not work there anymore but I am still in contact with her all the time. I enlightened her on things from an EMS side and she enlightened me on things from a nursing side.