Response to Paramedic vs. Nurses Article

The Gatekeeper blog wrote a recent article about an encounter he had while working as a paramedic and picking up a patient at a local nursing home.  The article on the Gatekeeper blog is entitled “Paramedic vs. Nurse.”

A familiar paramedic tale

Every EMS provider out there is familiar with this story. Most have experienced it personally. There are two things at work here.

First, let me begin channeling a character from “Cool Hand Luke.”

“Folks, what we have here is a failure to communicate!”

Nurses aren’t paramedics

The nurse has already contacted the doctor and the ER. She or he has orders to do what has been done. The main issue here is that they are used to working with aids, CNAs, and other unlicensed assistants.

A nurse in this situation is never asked detailed medical history questions by their unlicensed co-workers so they tend to think of everyone else other than nurses and docs as at the same level.

A wrong assumption, sure. We have to treat the patient and manage them on the way to the hospital.

Solution: Be patient (hard, I know). This nurse is also probably overseeing care of 10, 20, or even 30 patients and they all need attention, too. (See the second part of this article about different training focuses for nurses and paramedics.)

Apply the golden rule

We need to remember the old proverb reminding us to “walk a mile in the other’s shoes.”

Nurses and paramedics (and EMTs, too) do not understand how the two professions are different in their focus and training.

If you’re reading this, you know what the EMS providers are trained to do.

EMS providers focus on the golden hour and not on much beyond that hour of initial care.  EMTs and paramedics are trained to assess and treat immediate life threats. When treating a truly emergent patient, we often don’t have time to contact the physician directly.

EMS systems are protocol driven because of this time constraint and the street medic or EMT is taught to use their own interpretation and initiative to treat life threatening conditions based on standing orders.

Nurses are different, not wrong!

Nurses are trained to focus on a different type of patient care entirely. They are trained to deal with caring for the patient in terms of days, weeks, months, indeed a lifetime of health care focus.

Why does this cause a problem? Most new nurses have not received much emergency care training beyond CPR. Everything else is focused on carrying out direct physician orders, broader and more advanced pharmacological knowledge and common procedures and treatments seen in hospital care.

If there is ever a question about an order, there is usually plenty of time to ask a question of the on call physician and if not, there are standing orders to cover immediate care.

In a long term care facility, where the patients are considered sick but stable, anything that causes a patient to become potentially unstable necessitates a call to the physician. When this occurs after office hours, the physician response is to have the patient assessed in the ER.

The EMS/Nursing Oxygen Conundrum

As an example, in a long term care situation, concern about the hypoxic drive and high flow oxygen for the COPD patient is a real concern. Nurses may have seen this effect in action and know that patient’s will lose respiratory drive in response to long term high flow O2.  This takes hours or days to develop but this LONG TERM CARE.

EMS providers don’t worry about giving high flow oxygen to any patient because in the standard transport times we see, we will never cause the hypoxic drive to kick in and reduce respiratory rate before we get the patient to the hospital. It is understandable why we don’t see what the problem is with high flow O2 and in the patients in obvious respiratory distress we should follow protocol and give oxygen.

EMS Working Together with Nurses

I hope that this article has helped with understanding the differences between the EMS training and treatment focus and the basic training that nurses (RNs) receive.

The best way to alleviate this kind of conflict at local nursing homes is to work out some kind of cross training between the EMS service and the facilities. Helping the nurses understand our concerns will help with getting the information we need on arrival.

Learning about the issues nurses have about us (and they do have pet peeves about EMS) will help us be more aware of what they need us to do when we arrive to make their jobs easier.

Learn More About Nurses and Nursing Training

If you want to know more about nursing and how it operates while learning some additional patient care tips along the way, check out the Nursing Show podcast at NursingShow.com.  You can also find the Nursing Show on iTunes and the Nursing Show at the Zune Marketplace here.

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