[texasems-L]stirrin' the pot, read with caution

[Guest guest]

I apologize if I offend you with this topic, but I just have to bring these

issues to the surface.

I hate to represent EMS and stereotype us as being biased against NH, but this

is just a touchy subject to me. now I know a lot those who have " crossed over "

to the nursing world, and everyone always told me that if you think you don't

have a life now, try going through nursing school. all the horror stories about

your life consisting of work, eat, study, and if you get a chance you can sleep.

no my point being that if you have as an in depth education as they get in

nursing school, why are there so many people who you could swear up and down

that they got their LVN/RN out of a " CRACKER JACK BOX " . now moving along at the

speed of an arthritic snail, my points being:

1:

why is it every time you ask a nurse about a patient they tell you, " that's not

my patient, you'll have to ask their nurse " , even if the patient's chart is not

even an arm's length away.

2:

when you do find the patient's nurse and you ask them even the simplest question

like allergies or heck even the name of the MD(or DO), what is the first thing

they do? scramble through the paperwork. and heaven forbid it is a full arrest.

it would be easier to get blood from a turnip.

3:

why do so many nurses think that our title is " ambulance drivers " . I could have

sworn that the letters on my name badge says LP. maybe if we start calling them

butt wipers and they will get a chance to take a couple of steps in our shoes.

ok , I'm almost done venting

4:

who died and made the nurses holier that us. yea I know that nurses used to be

the ones that would ride on the ambulance, but you know what? we are all grown

up now and EMS is independent of nursing now. there is no need to have the

" HOLIER THAT THOU " attitude, cause there is only one place for nurses like that,

nursing instructors.

[Guest guest]

>>They don't have to tote their gomers, we do, so they get that holier

than >>thou attitude because they think they're getting one over on us.

That 'gomer' is someone's mother, father, brother, sister.

That 'gomer' may be a Bronze Star, Silver Star, Navy Cross, Medal of Honor

winner. (Ira was a gomer)

That gomer, at one time in their life was a musician, a poet, an engineer, an

entrepeneur, a CEO.... or a medic.

Pot, may I introduce you to the kettle?

[Guest guest]

Great post Meredith,

As an EMT married to an LVN who started her nursing career in a nursing

home, you hit the environment right on the head. To make things even more

interesting, the nursing home she worked at was in the first response area

for the VFD I was a member of. It was quite frustrating for both of us in

dealing with the sterotypes that came about from both sides.

One thing that I learned in watching the nurses, listening to my wife and

even from working there (in a non-medical position) was that things we take

as an automatic response in EMS aren't necessarily part of the LVN

curriculum or part of their ongoing training. It was not uncommon to walk

into a room with the nurse doing CPR without using the BVM or CPR board that

were hanging on the crash cart. Why? They weren't trained on them. Rather

than blast the NH staff as being incompetent, when I taught CPR classes to

the nursing staff I grabbed their crash cart and showed them how to use

their tools.

In this case it seemed to help break down the us vs. them mentality to we're

all want what's best for the patient so let's work together. Can't say that

it stayed that way since she left the home and we moved from the area, but

for those staff who were involved it at least broke down one of the bricks

in the wall.

Barry S.

Re: stirrin' the pot, read with caution

I'd like to add my two cents worth to this too....I started out as an EMT

and also wondered about NH nurses.

While going through nursing school I had the opportunity to speak to one of

my instructors about this (who

started out as a nurse before becaming an EMT) and what she said gave me

food for thought.

1. NH's are not learning environments. If you are a new nurse or an RN

working with an LVN (as in 2 nurses

to 20 patients sometimes), you don't have many people to learn from. Part

of the learning experience comes

from bouncing ideas off of more experienced colleagues. In the hospital you

can pick out those around you

who make good mentors. Same with EMS. In a NH, you may be on your own.

2. Another that seems to be the case (it seems to me anyway) is that the

mindset of nurses in NH vs. hospitals is that those who live in nursing

homes are not 'patients' but 'residents' . In most cases they are not being

'cured' of anything or even 'saved'. They are being 'maintained'. The same

treatment they would

get if they lived in their own homes. The nurses aren't used to critical

patients. They don't need problems

added to their already overwhelmed work load. They certainly don't seek

them out. Yet we learn from

problem solving, learn to critically think.

3. I've never waited for a Dr's order to put oxygen on a patient, even as a

nurse. So far no MD has ever had

a problem with it (now that I've jinxed myself....). However, if you're

inexperienced or haven't developed any

independent judgment, you tend to follow the rules to the letter. This is

true of any profession. The rules say you must have a doctor's order. Rules

are good, they're there to serve a purpose. But when you follow the rules

to the letter with out regard to why they exist, you wind up not serving the

purpose they were made to begin with. A lot of people forget this. They

are trying to protect their license, forgetting that the best way to do that

is to think of the patient first. I have to admit, they're more liberal with

this idea in EMS than they are in nursing. Nursing schools nowadays really

like to put the fear of the BNE in their students.

4. Morale can be terribly low in some of these places. After a while no one

tries to better themselves, it doesn't get them anywhere. A nurse can

usually give good care to no more than 4 pts, after that quality of care

deteriorates for each pt you add to that. A good nurse knows when she gives

substandard care and

it matters to her. Some NH nurses have ten or more. So they try to do the

best they can, pass out their

medications on time ( for those of you who don't know, there is a time frame

in which these must be given or it is considered a medication error.) and

put out fires along the way. Three patients have soiled themselves, they are

on her list to be cleaned up one after another, then a more urgent problems

comes up with another pt. But pt. 's daughter doesn't care about that,

she just comes screaming to the nurse she wants her mother cleaned up

yesterday. Then EMS comes asking about a patient that is not even assigned

to her. Hell, she didn't even know an ambulance had been called for anybody.

No reason she would. She's busy with her patients, nobody said anything, and

she doesn't have the power of osmosis. But the EMS crew treats her like she

is incompetent because she can't answer their questions. Who wouldn't

develop an attitude?

I hope that this at least explains some of the issues you have with

nursing homes nurses. Others I know it does not. To this day I'll never know

why, when a NH calls EMS and are expecting them, they can't spend those

minutes gathering basic information about that pt and have it ready. And

like EMS, NHN are also guilty of stereotyping. A lot of them expect to be

treated like crap by EMS, so they are on the defensive from the start. Like

someone else who posted to this, sometimes it is EMS with the problem. It

wouldn't hurt now and then for a medic to throw on a pair of gloves and help

roll a pt needs to be cleaned up before transport. Obviously not a code in

this scenario but you get the picture. I believe there are good NH nurses

out there, and they are probably the ones most likely to have a 'tude so

you don't exactly get the best of them. Empathy works best in these cases.

Instead of shooting questions at her she doesn't have the answer to and

then making !

her feel like an idiot, preface it with something like 'I know you're busy

and I hate to add to it, but I really need......'

Sorry this is so long. And it is not meant to be a rag. I'm sure

you and most of the others who post on

this board treat with professionalism other HCW who throw you for a loop.

Sometimes it makes one feel less frustrated if you get a little bit of the

other side. Good luck with your future dealing with NHN. I say this because

as a travel nurse I've gotten to work in different parts of the country, and

I don't recall any of the nurses I worked with saying they had any plans to

go to work in a NH.

With regards,

Meredith

stirrin' the pot, read with caution

I apologize if I offend you with this topic, but I just have to bring

these issues to the surface.

I hate to represent EMS and stereotype us as being biased against NH, but

this is just a touchy subject to me. now I know a lot those who have

" crossed over " to the nursing world, and everyone always told me that if you

think you don't have a life now, try going through nursing school. all the

horror stories about your life consisting of work, eat, study, and if you

get a chance you can sleep. no my point being that if you have as an in

depth education as they get in nursing school, why are there so many people

who you could swear up and down that they got their LVN/RN out of a " CRACKER

JACK BOX " . now moving along at the speed of an arthritic snail, my points

being:

1:

why is it every time you ask a nurse about a patient they tell you,

" that's not my patient, you'll have to ask their nurse " , even if the

patient's chart is not even an arm's length away.

2:

when you do find the patient's nurse and you ask them even the simplest

question like allergies or heck even the name of the MD(or DO), what is the

first thing they do? scramble through the paperwork. and heaven forbid it is

a full arrest. it would be easier to get blood from a turnip.

3:

why do so many nurses think that our title is " ambulance drivers " . I could

have sworn that the letters on my name badge says LP. maybe if we start

calling them butt wipers and they will get a chance to take a couple of

steps in our shoes.

ok , I'm almost done venting

4:

who died and made the nurses holier that us. yea I know that nurses used

to be the ones that would ride on the ambulance, but you know what? we are

all grown up now and EMS is independent of nursing now. there is no need to

have the " HOLIER THAT THOU " attitude, cause there is only one place for

nurses like that, nursing instructors.

[Guest guest]

Great post Meredith,

As an EMT married to an LVN who started her nursing career in a nursing

home, you hit the environment right on the head. To make things even more

interesting, the nursing home she worked at was in the first response area

for the VFD I was a member of. It was quite frustrating for both of us in

dealing with the sterotypes that came about from both sides.

One thing that I learned in watching the nurses, listening to my wife and

even from working there (in a non-medical position) was that things we take

as an automatic response in EMS aren't necessarily part of the LVN

curriculum or part of their ongoing training. It was not uncommon to walk

into a room with the nurse doing CPR without using the BVM or CPR board that

were hanging on the crash cart. Why? They weren't trained on them. Rather

than blast the NH staff as being incompetent, when I taught CPR classes to

the nursing staff I grabbed their crash cart and showed them how to use

their tools.

In this case it seemed to help break down the us vs. them mentality to we're

all want what's best for the patient so let's work together. Can't say that

it stayed that way since she left the home and we moved from the area, but

for those staff who were involved it at least broke down one of the bricks

in the wall.

Barry S.

Re: stirrin' the pot, read with caution

I'd like to add my two cents worth to this too....I started out as an EMT

and also wondered about NH nurses.

While going through nursing school I had the opportunity to speak to one of

my instructors about this (who

started out as a nurse before becaming an EMT) and what she said gave me

food for thought.

1. NH's are not learning environments. If you are a new nurse or an RN

working with an LVN (as in 2 nurses

to 20 patients sometimes), you don't have many people to learn from. Part

of the learning experience comes

from bouncing ideas off of more experienced colleagues. In the hospital you

can pick out those around you

who make good mentors. Same with EMS. In a NH, you may be on your own.

2. Another that seems to be the case (it seems to me anyway) is that the

mindset of nurses in NH vs. hospitals is that those who live in nursing

homes are not 'patients' but 'residents' . In most cases they are not being

'cured' of anything or even 'saved'. They are being 'maintained'. The same

treatment they would

get if they lived in their own homes. The nurses aren't used to critical

patients. They don't need problems

added to their already overwhelmed work load. They certainly don't seek

them out. Yet we learn from

problem solving, learn to critically think.

3. I've never waited for a Dr's order to put oxygen on a patient, even as a

nurse. So far no MD has ever had

a problem with it (now that I've jinxed myself....). However, if you're

inexperienced or haven't developed any

independent judgment, you tend to follow the rules to the letter. This is

true of any profession. The rules say you must have a doctor's order. Rules

are good, they're there to serve a purpose. But when you follow the rules

to the letter with out regard to why they exist, you wind up not serving the

purpose they were made to begin with. A lot of people forget this. They

are trying to protect their license, forgetting that the best way to do that

is to think of the patient first. I have to admit, they're more liberal with

this idea in EMS than they are in nursing. Nursing schools nowadays really

like to put the fear of the BNE in their students.

4. Morale can be terribly low in some of these places. After a while no one

tries to better themselves, it doesn't get them anywhere. A nurse can

usually give good care to no more than 4 pts, after that quality of care

deteriorates for each pt you add to that. A good nurse knows when she gives

substandard care and

it matters to her. Some NH nurses have ten or more. So they try to do the

best they can, pass out their

medications on time ( for those of you who don't know, there is a time frame

in which these must be given or it is considered a medication error.) and

put out fires along the way. Three patients have soiled themselves, they are

on her list to be cleaned up one after another, then a more urgent problems

comes up with another pt. But pt. 's daughter doesn't care about that,

she just comes screaming to the nurse she wants her mother cleaned up

yesterday. Then EMS comes asking about a patient that is not even assigned

to her. Hell, she didn't even know an ambulance had been called for anybody.

No reason she would. She's busy with her patients, nobody said anything, and

she doesn't have the power of osmosis. But the EMS crew treats her like she

is incompetent because she can't answer their questions. Who wouldn't

develop an attitude?

I hope that this at least explains some of the issues you have with

nursing homes nurses. Others I know it does not. To this day I'll never know

why, when a NH calls EMS and are expecting them, they can't spend those

minutes gathering basic information about that pt and have it ready. And

like EMS, NHN are also guilty of stereotyping. A lot of them expect to be

treated like crap by EMS, so they are on the defensive from the start. Like

someone else who posted to this, sometimes it is EMS with the problem. It

wouldn't hurt now and then for a medic to throw on a pair of gloves and help

roll a pt needs to be cleaned up before transport. Obviously not a code in

this scenario but you get the picture. I believe there are good NH nurses

out there, and they are probably the ones most likely to have a 'tude so

you don't exactly get the best of them. Empathy works best in these cases.

Instead of shooting questions at her she doesn't have the answer to and

then making !

her feel like an idiot, preface it with something like 'I know you're busy

and I hate to add to it, but I really need......'

Sorry this is so long. And it is not meant to be a rag. I'm sure

you and most of the others who post on

this board treat with professionalism other HCW who throw you for a loop.

Sometimes it makes one feel less frustrated if you get a little bit of the

other side. Good luck with your future dealing with NHN. I say this because

as a travel nurse I've gotten to work in different parts of the country, and

I don't recall any of the nurses I worked with saying they had any plans to

go to work in a NH.

With regards,

Meredith

stirrin' the pot, read with caution

I apologize if I offend you with this topic, but I just have to bring

these issues to the surface.

I hate to represent EMS and stereotype us as being biased against NH, but

this is just a touchy subject to me. now I know a lot those who have

" crossed over " to the nursing world, and everyone always told me that if you

think you don't have a life now, try going through nursing school. all the

horror stories about your life consisting of work, eat, study, and if you

get a chance you can sleep. no my point being that if you have as an in

depth education as they get in nursing school, why are there so many people

who you could swear up and down that they got their LVN/RN out of a " CRACKER

JACK BOX " . now moving along at the speed of an arthritic snail, my points

being:

1:

why is it every time you ask a nurse about a patient they tell you,

" that's not my patient, you'll have to ask their nurse " , even if the

patient's chart is not even an arm's length away.

2:

when you do find the patient's nurse and you ask them even the simplest

question like allergies or heck even the name of the MD(or DO), what is the

first thing they do? scramble through the paperwork. and heaven forbid it is

a full arrest. it would be easier to get blood from a turnip.

3:

why do so many nurses think that our title is " ambulance drivers " . I could

have sworn that the letters on my name badge says LP. maybe if we start

calling them butt wipers and they will get a chance to take a couple of

steps in our shoes.

ok , I'm almost done venting

4:

who died and made the nurses holier that us. yea I know that nurses used

to be the ones that would ride on the ambulance, but you know what? we are

all grown up now and EMS is independent of nursing now. there is no need to

have the " HOLIER THAT THOU " attitude, cause there is only one place for

nurses like that, nursing instructors.