lazy nurse or maybe clueless

[Lone Star]

tamaith:

So Welcome and I hear your frustration it IS hard to lose patients that you are doing your very best for, I am looking forward to more of your post and replys as there is a VAST amount of information on EMT city and perspective adjustment too, hey just look at Lone Star and Aussie Phil sometimes WE have to slap them silly !

cheers

*Wonders what he's getting slapped for this time*

[tniuqs]

Just your foot?

Umm OUCH ! Vent.

OMG who invited LS there goes the hood ... next thing you know aussiephil will be spewing upside down stuff ...

cheers

[cosgrojo]

Tamaith- It is important to have calls like these in the beginning. It is important because it shows you that you are in over your head. Hopefully you realize that, and you no longer take these calls for granted. I am not going to defend bad patient care, or laziness... but think about providing care to 20-40 patients at one time... We typically provide care to one patient at a time and can engross ourselves in the history of that one patient. SNF (Skilled Nursing Facility) staff have to provide care for the whole facility. It can be overwhelming. Not an excuse... just think about it.

One thing that has always bothered me is when EMS providers say "Oh, I only ever run dialysis transfers, never get really sick patients." WTF!?!?!?!? These are some of the sickest people on our planet. They have to get their blood taken out of their body, filtered, and stuffed back in 3 times a week just to live! These patients often have several co-morbidities that make them liable to crump on you at any moment. A good set of vitals is imperative for the treatment and care of a Dialysis patient. Never think that you can just mail it in on dialysis calls... they will bite you in the ass. I suggest doing a little research on Dialysis, it may just blow your mind what is actually going on with these patients.

P.S. tamaith, if you hit the shift button and then a regular letter key... it produces an UPPER CASE letter... just saying.

[tniuqs]

One more point to nit pick: SaO2 & SpO2 are not exactly the same concept.

Take care,

chbare.

Oops error .. busted.

<edit> Not the same means of measuring, SaO2 is mathematical calculation when doing ABGs extrapolated from the "spill over" of O2 to the blood plasma (.003) and measured by the Clark electrode, and a linear relationship.

SpO2 is finger pulse oximetry, (soon I have heard inter nasal spetal probes) this was discovered when a lab researcher inadvertently bled while evaluating the absorption of materials, (I can't remember the entire myth)was evaluating red vs infra red light absorption on different samples ... and by accident found that blood absorbed light, hence my point about good observational skills and just being curious and asking why, if the lab guy/gal did not ask why he would not be on a beach in the Caribbean sipping rhum punch today.

But NOW I am looking over my shoulder for LS and his open hand, followed by multiple slapping noises ..

cheers

Edited August 28, 2009 by tniuqs

[Just Plain Ruff]

all the nurse told us that pt was not responding, eyes were closed. i would think though a nurse would mention a fib for cardiac condition. under control or not its still a condition.

as for the second call we have tried to get our owner to make it so we ( crew on ambulance) can call on our radio's but won't do it. for whatever reason i don't know. the dialysis unit always calls for us. yes i understand its the ambulance that usually calls but in our situation im stuck. 99 percent of co workers don't have e.r. phone numbers in their personal cell phones. sometimes we will have our dispatcher call for us unfortunaltyl most don't speak good english. also for the screaming... a doctor looked right at us while we were asking for help but just sat back down in his/her chair.

compressed air? i couldn't tell you all i know is that its very popular at the dialysis units and nursing homes.

you are right nursing homes rarely have r.n s mostly just cna's but this one had r.n on the name tag. i am just in all. again i really don't see this type of work i predomintaly just do dialysis transports so to me this is all new.

If your boss doesn't allow you to use your nextel's or radio's to call the ER have you ever considered putting the ED phone numbers in your personal cell phone? At least you can alert them to a critical patient.

Does your service make a habit of not calling the ER's?

Maybe I'm missing something here.

[under-dreaming]

We all have the capacity to grow. Remember that OP.

There is so much for you to learn from these calls (especially the second one). However, on thing is puzzling me: is your ambulance equipped with BLS tools (BVM, Med O2, Defibrillator)? Have you ever had the opportunity to use those on a patient? I only ask because I have heard that some these transport agencies are little more than a transport van that holds a stretcher. Forgive my ignorance if this is not the case for you. cosgrojo mentioned that you are in over your head. You may have been on that day, but you can learn so much from this incident. The patient is in your hands until the nurse signs the PCR. Stay with the patient. If your partner wants to get the attention of the staff, let him/her. Just stay with the patient and stick with the basics. You can breathe for the patient and you can make the patients heart beat. If they need it, do it.

You might want to consider talking to your supervisor about getting a printed list with all of the ER phone numbers (since that is how your communication system works) and put all of those numbers in your cell. Good luck, and don't be afraid to do a little research.

[Katiebug]

First, a preface:

My first day on an ambulance, I didn't even know how to operate the stretcher. I have worked with many great, (and not so great), EMTs and paramedics since then and have come a very long way. My progress is due to the grace and kind teaching of those I have worked with as much as the experience I have attained. I include those on this site in my long list of teachers with a special shout out to chbare. I love you man.

Now, I have to agree with tniuqs. Don't eat the young. This is a great learning op for the OP. And for the record, I have no idea what INR is either. I'll click the link to it in a minute.

OP, what kind of moron owner doesn't let the ambulance crew communicate with the ER? What are you supposed to do if you need online medical direction? I bet there's a legal issue with that. Also, you have to let them know you're coming and what you've got. Is the owner even an EMT? He has to trust you guys to do what you are trained to do.

As for SNF and dialysis RNs, getting a good one is a crap shoot. Same way with us though isn't it? Sometimes you just have to pick up the slack for others where your patient care is concerned. It just sucks like that. At least you are here trying to better yourself like the rest of us. This is a great place for that if you can take the occasional slap to your ego. I've had mine slapped a few times.

I have to agree with the poster that stated dialysis patients are very sick people. I started my career doing dialysis txpt too. It's one of the things that inspired me to become a paramedic. My wife and I met at a dialysis clinic. I couldn't count the times I diverted to the ER both before and after dialysis treatment. A thourough assessment is so very important to these people. Many times the dialysis staff forget how sick they are too. They are subject to a myriad of other health problems that you should always be on the lookout for, ie: DM, cardiac issues, neuropathy, infections/sepsis, etc.

Keep on keeping on OP. Never get too comfortable in your job or take things for granted because as soon as you do, you will be thrown a curve ball that will humble you. Happens to me all the time. Especially now that I do 911. If you post a real life scenario here, make sure you have done all you could think to do for your pt, or you will get ripped a new one. Don't take it personally, let it make you better the next time. Nobody here knows who you are.

[Richard B the EMT]

1) Thanks, Medic Texas, for the link. As an EMT, I don't ever recall hearing that reference, and I've been working from 1973. Never too late to learn (or refresh).

2) When starting transport to the ER, can the dispatcher call and relay any information the crews find? It doesn't necessarily mean a request for an ER "Stand-By", just a "Note" (local nickname for a notification) to the ER, let them know what you're bringing them.

2-a) I monitor many radio frequencies, and notice that all ambulances I can hear from New Jersey, even doing transports for "direct admission" to a hospital that won't be seen in the ER, advise the hospital of what they are bringing in. I have had confirmation, both talking to local NJ crews, and NJ members of EMT City, that it is NJ State DoH policy to do so.

[wrmedic82]

ok 2 stories true stories that happen to me and my partner today. for anyone that doesn't know me i am an nremt b that works for a private company that 99.9% of the time just does dialysis transports. once in a while we ( the company) will get " emergency" calls to a nursing home we have a contract with to take the pt to the emergency room.

first nurse today . we get a call to go to a n.h. for an 82 yo male who is unresponsive.vitals are stable. no s.o.b. coa x 2 no jvd. no pain. no deformities/ abnormalities. my partner ( the tech) starts to ask the nurse what is going on ? nurse states pt was unresponsive for 60 seconds and now is sitting in the wheel chair on 2 lpm via nc. partner ask for the paper work and goes through it while getting info from nurse. nurse stated pt has a p.m.h. of heart problems but doesn't know what they are. my partner said wouldn't they be in your chart book on the pt. nurse: yeah i dont see them. partner: ok well what else can you tell me of the pt. nurse: pt has a history of a - fib. partner again ask nurse you don't know what cardiac problems pt has . nurse : no. partner: any other p m h we should know about ? nurse: no. as soon as we get on the elevator partner says to me: pt was sent here cuase of a history of syncope. i started laughing . partner says to me while the i was asking the nurse i was looking right at the big words primary diagnosis SYNCOPE.

wow. so the nurse couldn't figure out that a-fib is cardiac and maybe the reason ( not saying it was/ or is ) but maybe the pt had a syncope episode . maybe thats why the pt was unresponsive for 60 seconds. the nurse couldn't even tell us that the pt had a history of syncope. clueless or lazy?

2nd call

dispacted to dialysis unit for shortness of breathe. 63 yo female. had a full treatment. on 3lpm of compressed air via n.c. coax 1 nurse states pt is coughing up blood. resp 22. i appologize i forget pulse and b/p i do know they were both low. nurse stated that pt's i.n.r. is 6. and on the blood thinner coumadin. partner who i respect a lot and has done 9 11 for over 10 years and now doing transport ask what is i n r. the nurse looks at us starts to laugh and walks away. partner says no i really don't know what that is.please tell us. nurse doesn't answer. pt s condition is declining in the ambulance we pull up go to the er. where a nurse is on the phone. and a doc next to the nurse.. where i am ems has to wait for e.r. staff to acknowledge ems and pt. pt's eyes are closed. and now unresponsive in the e.r. partner asking for a nurse 4or 5 x each time voice is getting louder and louder. nurse on the phone says ohh the charge nurse will be right over. the doc looks at our pt and sits back down. partner now pretty much screaming hey can someone help over here who is better than me. finally another doc comes over feels for a pulse but doesn't feel one. so now after about 3 minutes goes by before we get help from staff . pt coded and was bleeding internal. er staff suctioned a lot of blood out of pt. my point here is why couldn't the nurse at dialysis tell us what inr was? lazy?

i can't blame to much on er. dialysis always says that they will call the e.r. for us since we don't have the e.r phone numbers in our radio's/ nextels since our boss has it so we can't dial reg phone numbers. ( why i don't know). er stated they( dialysis ) never called so they had no idea somebody was coming in. no i don't know 100% that the person on the phone was a nurse. i think so but not 100%. but why wouldn't the doc help us? why did another doc from across the other side come over to help when there was a doc right there?

anybody have experiences like this before?

tamaith,

I hate to say this but this happens like everyone else says more often than not. To take the advocate of nurses for a second, a single nurse can have as many as 15 patients or more. Im sure chbare can attest to this. A good RN yes will be able to rattle off everything under the sun about a patient. Some things may be left out due to various reasons. It happens we all have to deal with it. LVN's especially at NH typically don't dive into their patient's hx as much as they should. So it should not really be a shock to anyone that they didn't know the patient's hx upon your arrival.

As a EMT you are a health care professional. More so, its your job to find out all you can about a patient. Sometimes this means you have to play detective. Sometimes the answers concerning PHx are within the notes, medication lists, etc. Although going based on a med list can at times be misleading, it does kind of give you a clue as to what is going on with your patient(s). This is not really a new challenge, but an old one that you do everyday. If the syncope happened within a residency, and to add a degree of difficulty it was a 3rd party call. You would try to find out what meds your patient is currently taking, and if he is unresponsive you would try to piece what possible hx the patient has based on medications they are currently taking. Most people don't have a sheet just laying around in the open the tells their PHx. At a NH its really no different. Thats why patient assessment is important for every patient encounter you have.

Lastly, at every level of medicine there is ignorance due to lack of some type of education. There are really no exceptions to this. Thats why there is always room to learn, and to continue to learn. Where as some people do not take advantage of this, I encourage you to continue to learn all you can. Also encourage others to do the same. If a LVN doesn't know that atrial fibrillation is a cardiac condition, professionally educate them that this is cardiac. Maybe they knew it was cardiac but for whatever reason didn't feel it was pertinent even though it very well could have been. I don't know I wasn't there. But instead of being arrogant, we need to be professional, and help each other out. Just be tactful about it,and be ready to agree to disagree.

As for communication to the emergency department. If you have a cell phone. It maybe helpful to ask the ER for a contact number so that you can communicate with the emergency department when you have a incoming patient. This can be really helpful if your bringing in a suspected stroke patient or a STEMI. If your employer wont open the lines of communication like they should, be proactive and do it yourself.

Edited August 29, 2009 by wrmedic82

[tamaith]

thanks everyone for the comments. i think im done with this post. trust me def a learning experience ( pt did survive) as far as whats on our bls ambulance. gauze, tri- bandages, pen light, o2 ( main, port) occlusive dress, suction, bp cuff / steth. no monitors . unfortunatly the majority of the private bls companies are just in it to make money. they supply only the min of supplies needed to pass inspection. also i now have all the e.r. numbers in my cell. in fact i had to go back to that same e.r. today and yes i did call on my cell phone. thanks again for all your input.