HEMS providers working in ED/Hospital

[ChristopherM]

I was curious if anyone works for a program that officially assigns flight team members to work in the ED or other units either on shift or as an overtime opportunity.

At present, we are not typically tasked with such an assignment but can be asked to help out if staffing is short or if volume is high. In this case, we are able to work to our full scope of practice, though obviously under the direction of the provider. We are also able to volunteer to round on the units and help out, again with our full scope of practice. We are a busy program, but I try to do this as often as possible. It is a good way to connect with hospital staff and increases exposure to procedures that are less frequent for us like central line insertion. There has been some discussion of formalizing this role vs having providers go up to the units only on occasion.

 

[akflightmedic]

While good for your colleagues, it is bad in the sense it allows mission creep and never fully addresses the issues of why you even need to go round and assist to start with. It shows admin that even with your busy program, you are capable and willing to float and help. This means it will become the expectation and assigning of extra duties permanently. Just because you enjoy this and do not mind, how do your flight colleagues feel? And even if several are on board, is this something which should be encouraged?

As a busy program, shouldn't you be more encouraging of "downtime" being actual downtime?

There you are, in the middle of a procedure just helping out...then the tones drop, the tones for your actual job.

 

[ChristopherM]

While good for your colleagues, it is bad in the sense it allows mission creep and never fully addresses the issues of why you even need to go round and assist to start with. It shows admin that even with your busy program, you are capable and willing to float and help. This means it will become the expectation and assigning of extra duties permanently. Just because you enjoy this and do not mind, how do your flight colleagues feel? And even if several are on board, is this something which should be encouraged?

As a busy program, shouldn't you be more encouraging of "downtime" being actual downtime?

There you are, in the middle of a procedure just helping out...then the tones drop, the tones for your actual job.

I think you make some compelling points. My ideal situation would be the ability for crew to optionally pick up shifts in the units. And of course we also do clinical rotations which achieves a similar benefit though with less frequency. I imagine in the end the situation will remain unchanged but I was curious if other programs had found a workable model that the crew did not hate.

 

[VentMonkey]

It sounds like you’re at a true hospital-based service, or an HBS. My previous employer was an HBS in name only. Currently my program is not one, though our company has their share of HBS partners still around. All of this to ask:

Are you on 12’s or a full 24 hour schedule? It does sound impractical, especially if you’re working longer than a 12 hour shift.

 

[ChristopherM]

12-hour shifts. You are both correct that there are serious potential problems with the idea of being assigned to work in the units while on shift. I don't find it to be an issue currently as the vast majority of the time it is entirely voluntary. There have only been a handful of times I can remember when the request for help was made and then to be honest the main help needed were tasks that did not tie the crew up unduly.

There has been intermittent discussion over the years of expanding this role, and it is occurring again. I personally would not make it mandatory for those not interested, but I do see the value in the opportunity. Given roughly half of the employees seem to enjoy the ability to go help out in the units, I think it works to keep the system as is. The hospital still regularly gets assistance from interested crew members but it is not mandatory so that one could still choose to rest instead.

I appreciate the responses and insight.

 

[Akulahawk]

Whether or not you're a hospital based service, the problem is going to be that the transport nurses will end up potentially being counted on as additional staff within the facility. That leads to scenarios where the ED is a little short, so... hey flight nurses... can you help out over here??? Then those nurses end up getting stuck with a patient care assignment or some rather involved procedure. The programs I was familiar with usually had their nurses assist with tasks within the ED or in various units within the host hospital but because their primary assignment was transport (and 911 at that), they couldn't be used for tasks that couldn't be immediately walked away from. Fortunately their host hospitals didn't count on having those nurses available for staffing purposes...

One concern I have is when a crewmember picks up an extra shift within the hospital, that nurse should be appropriately oriented to that department/unit just as any other hospital float is. I'm all for having the opportunity for a transport nurse to pick up extra shifts in a specific department or to pick up a shift as a resource nurse of some sort for doing certain tasks, but it should be that... an opportunity and not a requirement.

 

[E tank]

You can take blood pressures on the med-surg floor...you're not doing anything anyway....

 

[ChristopherM]

You can take blood pressures on the med-surg floor...you're not doing anything anyway....

Well like I said I appreciate the insight. Clearly, it is not a common or popular practice.

 

[VentMonkey]

You can take blood pressures on the med-surg floor...you're not doing anything anyway....

I mean, this is pretty funny…

 

[ChristopherM]

I mean, this is pretty funny…

Yeah, no worries. Just saying I get the message.

 

[VentMonkey]

I mean, it’s a noble idea. I just don’t know anyone firsthand whose program is attached to the hospital this way. If it works, it works. Volunteering is always preferred over voluntelling, especially in a busier program.

 

[ChristopherM]

Yeah, that makes perfect sense. After thinking about it some more, I think my specific goals might be better achieved with (optional) additional clinical rotations with providers. But to be clear I am not in charge of the decision and have not been advocating mandatory work in the units. I imagine that it will prove unpopular enough that no big changes will be made where I work.

 

[E tank]

I mean, it’s a noble idea. I just don’t know anyone firsthand whose program is attached to the hospital this way. If it works, it works. Volunteering is always preferred over voluntelling, especially in a busier program.

The day someone just pitches in out of the goodness of their heart is the day pitching in becomes the expectation. Don't do it. The stink eye stares and sh***y comments about being lazy, selfish elitists will come whether you pitch in or not and are a small price to pay for completely ignorant administrators leaving you alone.

 

[Summit]

I'll go ahead and disagree with the "oh they are just gonna take advantage of you and not appreciate you" BS.

On 12 hour bases, it is completely reasonable to be expected to work the entire 12 doing whatever your employer calls on your to do within your skillset if you are not doing your primary duty.

If that is assisting in codes, trauma alerts, stroke alerts, mass transfusion, and hard IV starts, then that is good team integration and skill application.

If it is getting ED tech work done after you have fulfilled your required duties including CEs, then that is called doing your job even if it getting a BP, bring a patient water, or stocking a trauma room.

If you think wearing a onesie instead of 2 piece pajamas means you are entitled to sit on your butt while others work theirs off, then you are the one with the attitude problem.

If you don't like your job duties, get a different one.

 

[Akulahawk]

I'll go ahead and disagree with the "oh they are just gonna take advantage of you and not appreciate you" BS.

On 12 hour bases, it is completely reasonable to be expected to work the entire 12 doing whatever your employer calls on your to do within your skillset if you are not doing your primary duty.

If that is assisting in codes, trauma alerts, stroke alerts, mass transfusion, and hard IV starts, then that is good team integration and skill application.

If it is getting ED tech work done after you have fulfilled your required duties including CEs, then that is called doing your job even if it getting a BP, bring a patient water, or stocking a trauma room.

If you think wearing a onesie instead of 2 piece pajamas means you are entitled to sit on your butt while others work theirs off, then you are the one with the attitude problem.

If you don't like your job duties, get a different one.

As long as you don't get stuck doing something that you can't walk away from if you're called to go... pretty much this!!!

 

[Carlos Danger]

If you think wearing a onesie instead of 2 piece pajamas means you are entitled to sit on your butt while others work theirs off, then you are the one with the attitude problem.

If you don't like your job duties, get a different one.

If someone took a HEMS job knowing that they would be expected to work elsewhere on their downtime, then of course that’s totally fair.

But assuming that working in the unit or ED is something that a flight nurse is being made to do that wasn’t part of the original understanding of their job requirements, then there’s nothing about not liking that that indicates an attitude problem.

A flight nurse has responsibilities that are unique to their position that ED nurses aren’t expected to to help out with when the the ED is slow. and as others have pointed out, there are potentially serious problems with getting tied up in a procedure or patient assignment and then needing to leave quickly. And the slippery slope is a very real thing here also.

 

[VentMonkey]

While our “HBS” program didn’t have us help out in the hospital, we were expected to staff an ambulance in our 911 system anytime we were OOS, be it weather, maintenance, or staffing. As was a program the next county over.

Both were absorbed and turned into programs where this is no longer the expectation. I do not miss this, nor do folks from the neighboring program who were absorbed.