Have you ever confronted an ER nurse for being unproffesional?

[Ridryder911]

Oh BTW... anyone that describes that Nurses have to ask for orders and Medics do not.. actually displays their own ignorance and knowledge within their own profession! One might want to refresh the legal chapters of their textbooks and their own system regulations.

In the U.S.; no matter what level, state, region.... both Nurses and Medics have to work under medical direction (MD/DO). The form in which you receive orders is just difference in wording.

Before tooting one's own horn... better be sure you know the notes...

R/r 911

 

[TheLocalMedic]

What if the roles were reversed? How would you want nurses to respond if they saw an EMS provider do something they considered unprofessional or unsafe?

If I were the EMS provider, first I'd hope the nurses hadn't already drawn conclusions about me based on rumors, or even the reputation of EMS providers as a whole.

Next I'd want the nurses to approach me privately, unless they felt they needed to intercede in a clearly dangerous situation.

If the nurses still felt I was unprofessional or unsafe after discussing those concerns with me, I guess I'd expect them to go to my boss. I'd probably be angry if I thought they over-reacted, but at least I wouldn't be blind-sided by whatever came next.

^This.

If you have a beef, be an adult and address the problem. But do it in a constructive manner: politely and privately. "Calling them out" publicly will only earn you a reputation as an a-hole and make the person on the receiving end inclined to dismiss you as such.

I recently had an issue with a doctor which is a great example….

Our policy when bringing in a code stroke is to pause in the ER long enough for the doc to do a quick exam to confirm what we are seeing and then keep on rolling without taking them off our gurney straight to CT. However last week the doc (new to the area and probably unfamiliar with how we operate) kept hemming and hawing and poking around at the patient (who was exhibiting textbook symptoms) for about five minutes until we politely disengaged and just wheeled the patient over to CT with the charge nurse's blessing.

Granted, five minutes isn't a long time, but as they say, "time is tissue". I was a little frustrated at the situation, and felt that it needed to be addressed. I stuck around for a minute after completing my report until I saw that the doc wasn't busy and asked if I could bend his ear for a second. We stepped out into the hallway and I quickly voiced my concern and explained how we typically operate. He responded by saying that he'd just gotten the same talking to by the charge nurse and explained that this was the first code stroke that he had treated in the ED here and that this hospital operated a little differently (quicker) than wherever he was at before.

Result: I got to air my grievance and the doc got up to speed on how we operate. There was no recrimination or bad blood between us, and I believe we were both ultimately satisfied with the outcome.

 

[mycrofft]

Oh BTW... anyone that describes that Nurses have to ask for orders and Medics do not.. actually displays their own ignorance and knowledge within their own profession! One might want to refresh the legal chapters of their textbooks and their own system regulations.

In the U.S.; no matter what level, state, region.... both Nurses and Medics have to work under medical direction (MD/DO). The form in which you receive orders is just difference in wording.

Before tooting one's own horn... better be sure you know the notes...

R/r 911

An observation: there are some docs who will say "Go ahead, you know what to do, I'll sign it for you". They're the first to deny saying that, or refuse to countersign something, and will toss you under the longest legal train ever if it seems to be in their favor.

 

[Wheel]

Ah so much ignorance. I have never in my career asked a Physican to give an ACLS drug. I have these mystical things called "protocols" and "standing orders" too! I better go ask the Doctor what to do with them.

Everyone has guidelines/protocols, even physicians. I don't know why everyone gets so up in arms about what standing orders everyone has, when everyone has someone to answer to about the decisions they make.

Even listening to physicians talk, they have guidelines for stroke, sepsis, etc. that are put forward by their facility.

 

[JPINFV]

Now if only we can get someone in here repeating that tired BS about RNs have to ask the doctors permission to give O2 :rofl:

The admission order set at my hospital has a box we check for the "Give O2 to maintain SpO2 above 92%.
It's checked as a matter of routine, but that simply means that there's already a PRN O2 order.

 

[ExpatMedic0]

Its been a while....
Yes its more professional to take some one aside and address your issues at work instead of "calling them out."
Yes, both nurses and paramedics work under protocols and guidelines, and even doctors have guidelines. Nurses autonomy vary's dramatically on the nurses specialty, facility, and department, at least from what I have seen. I have worked at hospitals and transported to facilities where the nurses on a med/surg floor all had BSN's, but had to call "the IV" team to start IV's. They where not authorized to do do them as RN's at that hospital in that department. I have also seen where it was a protocol for them to overhead page the ED for a cardiac arrests on there floor, only to arrive to find them doing nothing or sometimes chest compression only. On the other side of the fence, those aren't emergency nurses. There are RN's who are on the flight team and critical care transport team with a higher scope of practice and more authority than the paramedic in some areas. There are also nurses in the ED who I have seen do EJ's and chest decompression under the supervision of the doc. There are school nurses and occupational health nurses who work completely alone with no supervision and runs the whole show.
At the end of the day, I would say ( at least from my own experience), Paramedics as a whole, make more independent judgment calls and have more autonomy. Their entire education framework and training is based around something very specific, aggressively treating emergency's outside of a hospital. Furthermore, its also based on the medical model not the holistic model.
I might get flamed for this, but I say this because nowadays in many systems, its not uncommon to have only 1 ALS provider (paramedic) on the scene orchestrating the entire thing, even preforming an RSI solo. That one(or maybe 2) provider makes a differential diagnosis on his/her own and also initiates an aggressive and rapid treatment plan independently on the scene. That is a lot of responsibility to put on one person, especially in such an uncontrolled environment. Its pretty rare to call medical control for permission to do something in many of those systems, but then again that depends entirely on your system.

 

[ExpatMedic0]

Then again... I am 31 years old, unemployed, living in student dorms, and most likely gonna be working as a CCEMT-Batista soon. So take what I say with a grain of salt ;-)

 

[mycrofft]

The responsibility is to assess and realize which protocol to follow, or to call for help if the protocols aren't fitting. Not to pick from an infinite sheaf of diagnoses and treatments.

Very good point, degree of "autonomy" (meaning, practically, action up to the point where you have to go ask for an order or consult) varies wildly depending upon the admin and the MDs.

GO for it, ExPat!