15 March 2010
Paramedic v. Nurse
**Newsflash** Hold all presses for news release, the Gate Keeper is an a$$ because he asks questions to a nurse. Well who woulda thunk. Let me fill you in on this one.
We’re called to a local managed care facility (nursing home) the other night for a patient experiencing some difficulty breathing. When we get there, as usual, there is no nurse with the patient who is in need of emergency treatment. Let me stop and spin tires here for a minute.
Would somebody please tell me why it is o.k. to call for an ambulance that is supposed to transport a patient who is supposedly sick enough to be outside the capabilities of the facility…and yet doesn’t have a nurse close by to manage said patient who is in such bad shape. Furthermore, why do the nurses not have proper training on the use of oxygen therapy and the delivery devices for said therapy? Really!?! Wouldn’t you think that we’d need to have that little baggie under the mask inflated just a little bit, and guess what my genius friends…five liters ain’t cutting it and two liters per minute with twenty feet of canula ain’t gonna do it either.
O.k., so I go to the patient’s room and sure enough she is having a rough time of it with her breathing. I ask a young lady who follows me into the room how long this has been going on.
“Oh I’m just an aide…I’ll go get the nurse.”, she says and scurries out of the room.
The patient is CA/Ox4 and also has some secondary issues with pain in her abdomen (RLQ) radiating down her right leg. For this she has had a morphine pump prescribed by her primary physician. I’m more concerned with the breathing since it is so labored with use of accessories. She is also pale and diaphoretic and which narrows my differential down even more.
Before long a nursely looking type appears in the room. I think I recognize this fella from the hospital, and if I’m not mistaking he also works in the CCU, so I breath a sigh of relief and start my interview with him. The patient was having such a hard go of it breathing, I didn’t want to stress her any more by getting her to talk.
I turned from the patient to ask the nurse, “When did all this start?”
“I’m not sure…I don’t work here all the time”, he answers not realizing he has just let me down already. Is this a standard response for any nurse who works in a nursing home that is taught in orientation or is there a special nursing class just for excuses and responses to EMS personnel?
It wouldn’t bother me so much if it was only every other time, but this is EVERY time I go to a nursing home to pick up a patient…any nursing home it seems.
Not thinking I continue on, “What kind of health history does she have?”
“That’s a good question”, is all I get.
Thinking that I may actually get somewhere with the next question, much to my chagrin I try again, “what types of medication is she taking”?
“That’s a good question too”, he responds
Really?!?! You mean to tell me that with two years training and many more years experience, the only thing that I have learned to do is ask good questions. What’s more amazing to me at this point is that this guy has just recently graduated from nursing school with the same two years of training, albeit in a different discipline. Of course you would think that a nurse would at least know the answers to some of these general assessment questions.
I’m just plain disgusted at this point and ask if we can get a chart or something or get someone who does know what’s going on with this patient.
Just then another nursely looking type walks in with some papers cradled in her arm. Maybe we’ll get somewhere with this one I hope deep from within my soul.
“Here’s her paperwork” she says while thrusting some papers in my direction.
“Whoa, just a minute…what exactly is going on here…how long has this been going on?” I ask.
“I’ve already gave the report to the ER and Dr. Hey’you wants her brought on over”.
“Well, that’s all fine and well, but I have to treat her between here and there…she’s not looking too good… I need to know exactly what’s going on”.
By this time I guess I had said some magic word that gave me security clearance to some personal medical history and events leading up to this point. She started in with her rendition of what was going on while I was in the process of hooking up the EKG, which showed an old infarct or even maybe an area of ischemia.
I’m going to stop here with the “case study” just because I want to preach a little bit about being a professional.
First of all, if a physician had came in my truck, dressed in the same uniform and asked the same questions, would it have made any difference what questions were asked. After all, are we not the eyes and ears of the physicians who have given us standing orders to act on their behalf?
I know there are nurses who don’t like us for one reason or another, and most don’t want to hear our reports at handover only because they are going to ask the same questions that we just did. Many more will certainly not want to hear about any pre-hospital treatment performed because that will just remind them that we do assessment based treatments rather than physician ordered treatments.
The reason that I’m so fired up over this is because this nurse happens to be friends with another friend of mine and called him to say that I just came across as a smarta__ and acted like an a___ole because of the questions I was asking.
I am a professional. I am a patient advocate. It is my job and responsibility to assess the mental acuity, history and needs of the patient and then render the treatments necessary to preserve life and/or the quality of life until care is turned over to a higher trained individual, or in most cases someone in their charge, such as a nurse.
It does not matter to me who the patient is, where they come from and it certainly doesn’t matter what their social standing is. I refuse to accept the mentality that just because a person is in an environment such as a nursing home, that they have given up all rights to make decisions for themselves if they are able.
I can not tell you the number of times I’ve heard a nurse tell a patient “you have to go, the doctor said to send you over” all the while the patient is protesting going anywhere. If the patient can tell me who they are, where they are, how they are and why I’m standing there…they’re in control of their destiny, period. Now I feel the need to clarify something here. I know that sometimes a patient will not want to go for fear that they might inconvenience someone, but if their condition warrants a visit to the ER, it is still my job to advocate for the patient and I’ll do everything in my power to encourage them to seek treatment. But it stops there. I don’t and will not participate in the coercion of a patient to do something they do not want to do.
For the ones who cannot speak and think for themselves, I wish I had the power to say (after a thorough assessment) “No there’s no need to for them to go to an emergency room” just because they bumped into a door. I would love to protect those that don’t need or understand what’s going on from the battery of test and the isolation of the ER.
My tongue will bare the scars from the teeth that kept me
from saying the things I want to say, but my conscious will be clear because I gave every patient the best even when others around wouldn’t.
**Just to note. This same nurse does in fact also work in the CCU. This is the same CCU where the students from ALS cources go to do their clinical rotations for their respective program training. Supposedly they have a lot to teach up there, but I’m sure this one doesn’t understand what his true responsibility is to the medical profession.