Hospital Staff Yelling at You

[pwtdkk71]

I'm a paramedic working for a fire department in a big city. I have been a medic for nearly 14 years. I love my job but of all these years, the biggest disappointment I have is the following....

** Nurses and doctors ( mostly nurses ) being rude to me because I inconvienced them for bringing them a patient or yelling at me because I didn't start a propholactic IV on a 90 year old lady c/o general weakness who was otherwise stable. I guess I thought medics and hospital staff were all tight and friendly since we all work together. It's the opposite in a lot of the hospitals I bring my patients to. Yes, if I make a major error..i.e, drug error or some other major error, call my superiors because I needed to be educated/reprimanded. But if it's because my patient had some kind of condition that I would have no way of knowing out in the field...i.e, head bleed from a sneeze or cardiac issue when they only complained of shoulder pain after I ran a 12 lead and was negative and I sent them BLS.....why don't they contact me directly so I can learn from my mistakes and have a working relationship with them...not cause hostility cause they go right to my superiors to complain about me. I'm tired of these nurses having bad attitudes when all I am doing is bringing them business.

I have called nurses out and told my superiors who called the ED Manager to talk to their employees. It may change for a month or so..but eventually they all go back to being jerks. I tell them it must be nice to have a nice, clean, controlled environment to work on patients. Try being on a side of a freeway at 1 in the morning in the dark with a car on its side and cars going by you at 80 mph and working on someone....

Are today's nurses being told they are our bosses? Anyone have any suggestions?

 

[VFlutter]

I tell them it must be nice to have a nice, clean, controlled environment to work on patients. Try being on a side of a freeway at 1 in the morning in the dark with a car on its side and cars going by you at 80 mph and working on someone....

Don't be "That Guy"...

Are today's nurses being told they are our bosses? Anyone have any suggestions?

Most RNs are not really told much about EMS in school. Outside of the ER most do not know the difference between an EMT and a Paramedic.

Can you be more specific on what they have said to you or complained about? Although there are some Nurses out there with bad attitudes most are not rude and yell for no reason.

Best advice I can give is kill them with kindness and try to see what you can do on your end to make the interaction better. Unless they are truly unprofessional and disrespectful then by all means talk to your supervisor.

 

[mycrofft]

An evil culture has arisen at that ED. Good luck with that.

Remember that anyone who isn't "yelling" will not be noticed. By that token, it will always seem everyone is yelling if they number more than, say, two.

The change has to be between your boss and their boss, but individuals on each side will need to be patient and sweet and all that until a new paradigm is adopted, or the good people quit and leave them to play with themselves.

 

[pwtdkk71]

I think the word "yelling" in the literal sense was a little inaccurate on my part. I think more accurate would be scolding,complaining, or condesending. Of course it's not all of the ED Staff because there are some great nurses and doctors. But a higher % than one would think lurks out there against medics and EMTs. I did have a friend tell me he believes nurses are "jealous" because we can do things on standing orders while they cannot. Yes, there are lazy medics and EMTs out there who do the bare minimum at best and that would be frustrating to the ED Staff accepting the patient....let alone the care the patient deserved before hospital arrival that they did not get.

My frustration is when I as well as my co-workers, are treated with hostility and threats because we didn't start a prophlactic IV on a 400 lb person who has stable V/S or wasn't able to catch the ICB from a patient whos only complaint was an earache. How would I know the pt has bleed from that especially if their medical hx was none? If I activated the stroke receiving center for every earache, they would have my you know what in a sling.

And if I call the hospital to find out what happened to a pt. I brought in, you'd think I was trying to get their ATM pin numbers! "Can't tell you, HIPPA, that nurse went home, can't find patient in system, I'm busy, tell your boss to call my boss!" Same excuses all the time.

How do we grow in our knowledge as medics when we don't see the outcome of the patients? I tell the nurses you don't have time to tell me the outcome of the patient, but you have the time to call my bosses and complain about me or my care ( or perceived lack of ).......funny how you have time for that.

 

[VFlutter]

] I did have a friend tell me he believes nurses are "jealous" because we can do things on standing orders while they cannot.

Sorry, but this made me :rofl:

 

[mycrofft]

Quote:
Originally Posted by pwtdkk71 View Post
] I did have a friend tell me he believes nurses are "jealous" because we can do things on standing orders while they cannot.
Sorry, but this made me :rofl:

Speaking as a nurse and former EMT, you may hear that a lot but the originator is ignorant or malicious*.

Nurses get to do various amounts and with varying degrees of autonomy except for two things: they must follow their standardized procedures or protocols, and their work is overseen and signed off by a physician. I know nurses who basically execute MD's orders all day and oversee subordinates. I on the other hand had an inches-thick binder of SPs and saw up to 50 odd patients a day to screen and in some cases order and treat. All depends on what you can perform and where you work.

Nurses may be envious of field folks "driving around, eating hamburgers, picking up and dropping off patients and doing stuff to irritate us". But when most think about EMT's at all, it is to wish they were more in tune with the realities of the ED, and in some cases, as people they can bully about as some sort of underling. Others do both, use the excuse or occasion of necessary feedback to act patronizing or superior.

Personally, I think clinical feedback should be from the MD, and anything a nurse says to a a field technician (I include emts, paramedics and etc's) ought to be collegial and above-board.

* Malicious: stirring trouble. Ignorant: in need of some information, which is readily addressed if the subject will listen and believe.

 

[usalsfyre]

My frustration is when I as well as my co-workers, are treated with hostility and threats because we didn't start a prophlactic IV on a 400 lb person who has stable V/S

Define prophylactic. If the patient needed medication or fluid for symptom relied and you didn't do it because it's "not your job to treat pain or nausea" than you deserve every bit of crap you catch.

or wasn't able to catch the ICB from a patient whos only complaint was an earache. How would I know the pt has bleed from that especially if their medical hx was none? If I activated the stroke receiving center for every earache, they would have my you know what in a sling.

My honest guess here is the patient had some other signs and symptoms with that "earache" that you overlooked. MOST ED staff I've dealt with understand when you get caught by the truly occult issue. Unfortunately far too much stuff is missed because a large percentage of medics write problems off as malingering if it doesn't slap them in the face.

And if I call the hospital to find out what happened to a pt. I brought in, you'd think I was trying to get their ATM pin numbers! "Can't tell you, HIPPA, that nurse went home, can't find patient in system, I'm busy, tell your boss to call my boss!" Same excuses all the time.

How do we grow in our knowledge as medics when we don't see the outcome of the patients? I tell the nurses you don't have time to tell me the outcome of the patient, but you have the time to call my bosses and complain about me or my care ( or perceived lack of ).......funny how you have time for that.

Probably due to poor relations with staff...

I'm going to be honest. You sound like a guy who's trying to improve but you're using all the same old tired EMS cliches. "Controlled environment", "No CT", "Jealous"....it's all bull excrement. All of it. The fact is as a medic you're undereducated and over-confident due to training. The out and out bufoonery our colleagues engage in on a regular basis doesn't help. Be humble and realize even a second year EM resident or nurse would be far better than most medics in the field with a small amount of training.

Or, there's a good possibility you're trolling, in which case

 

[mycrofft]

"How would I know the pt has bleed from that especially if their medical hx was none?"

Otoscopy maybe. Have one? Trained/certified in using one?
(A real otoscope is an expensive tool but I think anyone looking down throats and into ears needs training and to have one available).

 

[NomadicMedic]

You may notice when you start treating the nurses with respect and give them information that they need in a concise manner, the yelling stops.

If you appropriately treat patients, the yelling stops.

If you're honest when you walk into the emergency room with a patient and say, "I have no idea what's going on here. But I started a line and drew some bloods." There's not much anybody can say that.

In other words, do your job and be a nice guy… And you'll never have issues with nurses.

(The one caveat is some nurses are just evil monsters. They fight with everybody.)

 

[mycrofft]

Agreed. Can I frame that?

 

[VFlutter]

(The one caveat is some nurses are just evil monsters. They fight with everybody.)

Like me? :unsure:

 

[NomadicMedic]

You were who I had in mind.

 

[medichopeful]

I did have a friend tell me he believes nurses are "jealous" because we can do things on standing orders while they cannot.

Have your friend go spend a day in an ICU or some EDs and see what he thinks about this statement at the end of the day

 

[Carlos Danger]

I did have a friend tell me he believes nurses are "jealous" because we can do things on standing orders while they cannot.

I can assure you that 99.99% of the time, this is NOT the problem.

Most nurses don't know what EMT's and Paramedics do, and couldn't care less.

Yes, there are lazy medics and EMTs out there who do the bare minimum at best and that would be frustrating to the ED Staff accepting the patient....

This and lousy, too-long reports are a big part of the problem.

Another part of the problem is that a busy ED is a ridiculously high stress, miserable place to work, and people who work there tend to be cranky.

Neither of those is justification for treating you badly, of course.

And if I call the hospital to find out what happened to a pt. I brought in, you'd think I was trying to get their ATM pin numbers! "Can't tell you, HIPPA, that nurse went home, can't find patient in system, I'm busy, tell your boss to call my boss!" Same excuses all the time.

This is probably a system problem that has nothing to do with the individuals you approach asking for info. The people you approach don't know you from Adam, and are probably instructed to NOT give patient info to ANYONE. Even if they do know you and are allowed to help you, they are probably too busy.

Your service needs to set up a formal mechanism for gathering follow-up information. Just walking up to someone sitting at a computer is not the way to do it.

 

[CentralCalEMT]

It sounds like it could be a huge miscommunication problem more than anything.

If you work in a big city EMS system is it possibly because many nurses do not know the medics on a personal level? They probably see 20 different ALS units and like 30 different paramedics every day and never get to know anyone. Therefore you all become faces in a crowd. Perhaps your or another department that transports there has several crappy medics who therefore make everyone in the crowd look bad. Then when the nurses see paramedics they think they are idiots. Not that it justifies any unprofessional behavior but that is what happens. My area has less than 20 full time paramedics so we are known by name so it's a little different in smaller areas.

Also, the nurses were not on scene with you. All they know is a bleed or cardiac event showed up BLS. They do not know if you asked one question or 30. All they know is a supposedly low acuity patient became a lot more serious and will tie up a lot more resources. You might have asked 30 questions as you seem to want to be a good paramedic, but we all know that lazy medic that doesn't. Perhaps they expect IVs on patients that you know will need fluids/CT scans/meds at the hospital as a courtesy to them since they are really busy but they do not know your protocols and what they say about IVs. All they see is paramedic X does not start IVs while paramedic Y does on those patients. Do you have a EMS liaison that might be able to set up an inservice or other training for the hospital about what you do? Many of the RNs in the area I work have rode along with us and this has increased understanding and mutual respect.

Again, there is no justification for unprofessional behavior but sometimes it is just a bunch of miscommunication.

 

[DrParasite]

Most nurses don't know what EMT's and Paramedics do, and couldn't care less.

which is one of the problems... And not for nothing, it's an issue on the nurse's side, not on the side of EMS. I can lead a horse to water, but I can't make it drink...despite the fact that is it insisting that I deal with the horse day in and day out.

This and lousy, too-long reports are a big part of the problem.

Another part of the problem is that a busy ED is a ridiculously high stress, miserable place to work, and people who work there tend to be cranky.

Neither of those is justification for treating you badly, of course.

I'll agree with everything you said. The same can also be said for incredibly busy EMS systems.

It sounds like it could be a huge miscommunication problem more than anything.

If you work in a big city EMS system is it possibly because many nurses do not know the medics on a personal level? They probably see 20 different ALS units and like 30 different paramedics every day and never get to know anyone. Therefore you all become faces in a crowd. Perhaps your or another department that transports there has several crappy medics who therefore make everyone in the crowd look bad. Then when the nurses see paramedics they think they are idiots. Not that it justifies any unprofessional behavior but that is what happens. My area has less than 20 full time paramedics so we are known by name so it's a little different in smaller areas.

bingo. when you are an unknown, you tend to get a lot of crap. when you know their first name, you get treated better. when they know yours, even better. when you have seen them dancing on the bar at the christmas party, that you were invited too, well, you get the idea.

I used to work in a small urban city (about 6 sq miles). I knew most of the nurses. they knew me. they knew I know my job, and I knew what I was doing. The doctors knew me by face, if not by name. Other healthcare providers are more willing to pull you aside to discuss an issue when they actually know who you are and will see you in a few days, vs a nameless provider who they easiest way is to contact your supervisor and have them investigate.

Also, the nurses were not on scene with you. All they know is a bleed or cardiac event showed up BLS. They do not know if you asked one question or 30. All they know is a supposedly low acuity patient became a lot more serious and will tie up a lot more resources. You might have asked 30 questions as you seem to want to be a good paramedic, but we all know that lazy medic that doesn't. Perhaps they expect IVs on patients that you know will need fluids/CT scans/meds at the hospital as a courtesy to them since they are really busy but they do not know your protocols and what they say about IVs. All they see is paramedic X does not start IVs while paramedic Y does on those patients. Do you have a EMS liaison that might be able to set up an inservice or other training for the hospital about what you do? Many of the RNs in the area I work have rode along with us and this has increased understanding and mutual respect.

wah wah wah, poor babies. so sick patients never show up at the ER triage doors? That they need to devote a lot of resources too? I don't buy it.

I will say this: if you have a sick patient, as a courtesy, you shouldn't show up at the ER doors and say "here you go." Call ahead, let them know you have a sick patient.

Again, there is no justification for unprofessional behavior but sometimes it is just a bunch of miscommunication.

agreed

 

[mycrofft]

We had a problem in Omaha, in that the report form was one of those legal size, fit everything onto the front type forms so packed with tiny data blanks to fill they resembled the old fashioned theater fire curtains:

I actually looked back and watched the ER's lead nurse throw our form out as they started all over again.
Looking back, I don't blame them, but they needed to talk to us and our boss about it

 

[DCAPBLSTIC]

New Nurses

I would guess as well Nursing is not what it used to be with the massive retiring age and demand for new nurses schools sometimes don't screen candidates to the full potential.

 

[mycrofft]

Teaching nurses to be nice to field people is not even on their minds, students nor schools.

 

[Airlinepilotmedic]

I work for a busy, mid-size, urban Fire Dept in Southern California. We have our own ALS ambulance transports, staffed with 2 FF/medics. On average 85% of our calls get transported to the same large county hospital. We are fortunate that our Dept Medical Director is also a senior fellow and attending physician at the same hospital. A few years back he implemented a once a year ride out program for all ED staff including RN, PA, MD ect...

The 12 hour ride out tremendously helped us build a closer cohesion, understanding and respect for each other. The ER MD, PA, and RN's gain a better understanding and respect for practicing in "the field" and how different and dynamic it can be. On the flip side we are able to pick their brains and find out what we can do on our end to make their jobs easier.

A few weeks back I had an anesthesiologist riding out with us on a CPR, I offered to let him get the tube, but since the guy was wedged in the back of a trailer with little light he politely declined. He joked afterword that he will stick to intubations in a well lit surgical suite. Conversely, he provided us with some great techniques to use on difficult airways.

Since the program was implemented we have had zero issues between ourselves and the ED staff. If anything it has helped us become better at our own jobs by opening the lines of communication so both ends are open to constructive criticism and creating an environment of being on the same team, compared to the us vs them mentality that used to be so prevalent.