Med control for Morphine?

[rhan101277]

So i was at clinicals today discussing with a RN about paramedic procedures on a pain medications since we were just getting through giving some. She said even a paramedic must call med control before administration of a narcotic. We can administer it without med control though so I decided not to argue.

Further discussion occurred later in the day about pre-hospital diagnose which she basically said was hogwash. I explained that one must be developed so we can decide which protocol to follow and left it at that.

I don't know if this RN was having a bad day, the rest were fine and all, but I decided I am not going to discuss any medication administration or procedures unless I absolutely need to. Most RN's are great, this one seemed to have a dislike for paramedics and/or their ability to make decisions with little supervision.

[Lifeguards For Life]

Originally Posted by rhan101277

So i was at clinicals today discussing with a RN about paramedic procedures on a pain medications since we were just getting through giving some. She said even a paramedic must call med control before administration of a narcotic. We can administer it without med control though so I decided not to argue.

Further discussion occurred later in the day about pre-hospital diagnose which she basically said was hogwash. I explained that one must be developed so we can decide which protocol to follow and left it at that.

I don't know if this RN was having a bad day, the rest were fine and all, but I decided I am not going to discuss any medication administration or procedures unless I absolutely need to. Most RN's are great, this one seemed to have a dislike for paramedics and/or their ability to make decisions with little supervision.

I too have been put in many similar situations and am under the impression may rn preceptors i have had do not wish to have a student, and few seem too incompetent to have a student. I have had many paramedic preceptors that did not seem to know a whole lot.

And our medical director is pretty aggressive, we can give narcs in the field without consulting medical control as well.

[FFMedic75]

Alright guys, here is the deal with the nurses. Remember the majority of them (with some exceptions i.e. flight nurses, NP, etc.) do not make decisions, they simply do what the doctor says. The old adage in EMS that we don't diagnose as medics is BS. Why do we do 12 Leads or take BGLs? We diagnose symptoms and in many cases make definitive diagnoses prior to arriving at the hospital. One example of this is transporting STEMI patients directly to the Cath Lab. Many of the Nurses you will encounter are jealous of this. Lots of others are just plain burnt out. Having said that while doing clinicals you are there to practice specific skills like medication administration and IVs. The majority of your patient assessment skills and clinical decision making will come when you do field internships. The Paramedic Preceptors will be much more prepared and understanding to teach this. My best advice now and throughout your career is not to piss off the nurses just go there practice your skills and be proactive.

[Lifeguards For Life]

Originally Posted by FFMedic75

Alright guys, here is the deal with the nurses. Remember the majority of them (with some exceptions i.e. flight nurses, NP, etc.) do not make decisions, they simply do what the doctor says. The old adage in EMS that we don't diagnose as medics is BS. Why do we do 12 Leads or take BGLs? We diagnose symptoms and in many cases make definitive diagnoses prior to arriving at the hospital. One example of this is transporting STEMI patients directly to the Cath Lab. Many of the Nurses you will encounter are jealous of this. Lots of others are just plain burnt out. Having said that while doing clinicals you are there to practice specific skills like medication administration and IVs. The majority of your patient assessment skills and clinical decision making will come when you do field internships. The Paramedic Preceptors will be much more prepared and understanding to teach this. My best advice now and throughout your career is not to piss off the nurses just go there practice your skills and be proactive.

very well said. i

[rhan101277]

Thanks for the advice. Where I will be working after class won't be in this area though. I still want to make friends, so I will just do what I am told and try to get in there and get stuff done. I have only been successful on 3 out of 13 total IV's attempted, most were hard sticks, hopefully I will get better.

[downunderwunda]

Whats Med Control?

Waste of time.

You have the training, you have the knowledge, you should not have to talk to some Doctor to get permission to provide pain relief.

[rhan101277]

Originally Posted by downunderwunda

Whats Med Control?

Waste of time.

You have the training, you have the knowledge, you should not have to talk to some Doctor to get permission to provide pain relief.

And you don't, just an RN getting grumpy.

[mycrofft]

1. Some nurses are very status/pecking order oriented, and an EMT seems easy pickings. Or Peckings.
2. Some EMT's come in very self-inflated with their boots and their windshield punches and their stethoscopes around their necks and do not do what the receiving staff want, which is bring the pt in pumping with the data the staff needs, then get out. Sometimes stuff goes missing.
3. Some nurses or EMT's are not good at precepting anyone, and there is probably a rotation set up for who will watch the student that shift. I have met EMT's and RN's who refuse to help new people.
4. Some EMT's or Nurses are simply having a very cruddy day or life and you are the closest harmless thing to biff around.

Say to your preceptor "I am feeling that I am not doing anything right. Can you tell me specifically what I have to do better?". Write down their answer, or get it in writing and time and date it. If the answer is "Nothing, you're doing fine", it's your choice to talk about it or go to your instructor and ask for another preceptor. If the feedback seems odd or not real, take it to your instructor and talk about it. If the corrections are at all realistic, thank your preceptor and ask more questions about how you are doing.
If the preceptor says "You aren't cut out for this", consider it for a second, then talk to your instructor.

Been there done that.

As for the drug issue, learn your protocols but make sure the count is right at the beginning end and whenever you take out a narc, and when you are leaving shift you count the actual narcs to the oncoming person who looks at the book (or whatever), or you both count and read together. NEVER change shift by allowing the offgoing staff to hold the book and have the count read to them (too easy to say "good count" and instantly put it on the oncoming shift).

[daedalus]

Ugh. I HATE the direction these threads go sometimes. While there may be very few RNs that envy being out in the field (I assure you, very few of them really want to be out on a rig when they could be making much more cash in the ED), there are many more paramedics I know who envy the RN's job. I say from experience, a lot of my paramedic partners have plans on going the RN route for better job stability, better benefits, better pay, better family friendly job.

Also, very few RNs work under the old prejudices people have of them. They do not silently wait for orders from an MD and than go carry them out. Please shadow an RN in a modern ED or ICU/PICU/NICU/CCU if you do not believe me.

In one nearby trauma center, the RNs typically have "ordered" most lab work before the doc sees the patient, and the MD/DO/PA just signs off on it. If you cannot do this competently, you will not last in that ED.

Also, common. RNs require a college education. We do not. Automatic trump. As painful as it is to admit, we have to fix this.

OP, I have encountered your situation as well. Keep your mouth shut and skate through your clinical and than in the field you will get to give all the morphine you want without calling base, and you can smile about it. You get what I mean.

[VentMedic]

Originally Posted by FFMedic75

Alright guys, here is the deal with the nurses. Remember the majority of them (with some exceptions i.e. flight nurses, NP, etc.) do not make decisions, they simply do what the doctor says. The old adage in EMS that we don't diagnose as medics is BS. Why do we do 12 Leads or take BGLs? We diagnose symptoms and in many cases make definitive diagnoses prior to arriving at the hospital. One example of this is transporting STEMI patients directly to the Cath Lab. Many of the Nurses you will encounter are jealous of this. Lots of others are just plain burnt out. Having said that while doing clinicals you are there to practice specific skills like medication administration and IVs. The majority of your patient assessment skills and clinical decision making will come when you do field internships. The Paramedic Preceptors will be much more prepared and understanding to teach this. My best advice now and throughout your career is not to piss off the nurses just go there practice your skills and be proactive.

Here we have another one who has absolutely no hospital experience and knows absolutely nothing beyond the back of an ambulance or fire truck. Yet, he feels the need to spout such crap to bash RNs to make up for whatever inadequacies exist in EMS and in himself.

The major difference between RNs and those in EMS, besides the education, is that they know who they are and what they are capable of. They also know when, why and how to gain more education and respect in medicine. EMS still believes a few hours of training and their ability to drive real fast with their L&S automatically gives them respect.

There are many EMS services such as Washington DC that didn't have access to even valium or morphine until recently. I believe the morphine is still on a very limited basis with lots of hand holding from medical control. There are some EMS services in the U.S. that don't start any type of IV medications or fluids without medical control. There are also some areas such as California that just can not do much of anything due to their very limited state scope of practice which is why RNs are used on the CCTs and Flight teams.

One of the reasons RNs and RRTs are utilized for Specialty teams is their ability to have very extensive scopes of practice extended to them by their states since they do have an established educational foundation that is consistent for the minimum and based on a college degree not a trade school diploma stating a few hundred hours. Thus, their job description can be as broad as necessary to get the job done. Even working on a flight team as a Paramedic with a fairly progressive scope of practice, I am still very limited when compared to my RN partner. In the ICUs and other nursing areas, there is no comparison as the RNs have extensive protocols to follow which fill books much larger than almost any Paramedic system in this country.

However you are correct that the Paramedic preceptors should be better prepared to explain how it is in EMS. Most nurses will have a difficult time understanding how someone can do x but can not do y or how some don't even see that x and y should go together. Essentially, the limiting recipes of EMS make no sense to hospital staff who are about total care of the patient and providing all the meds necessary when needed and not "just this much". Sedation and RSI are good examples when the patient is given just enough to p** them off when procedures are attempted and not enough to do any good.

My other message to you is not to attempt to bash other health care professionals in an attempt to hide the problems that exist in EMS. Maybe if you address the problems that give rise to such discussions about EMS providers amongst other health care providers, there would be little need for threads like this.