The Elephant In The Room...

Dear Nurses (Floor Nurses, ED Nurses, Nursing Home Nurses, etc.),

Hey everyone! It's your friendly neighborhood EMT. I'm writing because I've been feeling a little bit of... well, tension in our relationship lately.

A wise person once said, “If there's an elephant in the room, introduce it.”

Well, meet the elephant. The EMS and Nursing relationship. We have become the equivalent of two rivaling cliques in high school.

It's high time the tree-hugging hippy guidance counselor comes in and we all sit down and talk things out. Unfortunately, our resident hippy is busy making his own granola, so you're going to have to settle for me. I don't own any tie died shirts, but I do rock a wicked pair of BDU's at work, and own more than one pair of scrubs. Oh, and I make a phenomenal pot of coffee.

You know, we have a lot in common.

We both do our fair amount of complaining about each other. Some of it is warranted. Most of it isn't. I don't expect this to change. There are just as many bad apples who are burned out in EMS as there are in Nursing. This is not going to be one of those feel good posts where I say, “Hey, we're all on the same team, folks! Why can't we just get along?” That would be unrealistic and ridiculously cliched. (Although the Utopian idea of all of us treating each other with at least the minimum level of professionalism does appeal to me.)

My background is in EMS and my story is typical. I left a great job with great hours and benefits to become an EMT-B and work at a private ambulance service. I took a 50% reduction in pay, and I work 50-72 hours a week. I miss holidays, I miss school events, and I miss a lot of the every day stuff going on in my kids lives. I decided to further my education by becoming a Paramedic, and I just started school (again) to do that. It's a 12 month program that in addition to all of my regular hours at work is going to equate to over 5000 hours away from my kids over the next 52 weeks. I could make more money doing something else. Hell, I could make more money working as a greeter at Walmart. I choose to do this job because it makes me feel good to know that I've helped someone.

Some of this probably sounds familiar to you. Nursing and EMS are both tough jobs. We both work long hours, we all get stressed out, and we all miss the same family events. You get just as frustrated as we do. We both have management entities that put unrealistic demands on us. We both have drunks who are angry psych patients who can be physically violent. We both hold a lot of hands and comfort a lot of people. We both put up with exorbitant amounts of BS.

We have a few things in common. At our core, we all want to help someone who needs it.

I realize that I said I wasn't going to turn this into a pep rally. I'm not. Speaking as an EMT, my hope is to shed a little light on why we do some of the things we do. I want you to understand us a little better.

We might bring in a patient who has absolutely no need to be on an ambulance or in the ED. We know this when we bring them in. We know that we're just adding to your work. None of us enjoy the fact that we have to do it. As an EMT I'm not allowed to tell a patient “No. Drive yourself to the ED, or here's an idea, go see your Doctor!” Believe me, most of the time I have to bite my tongue. It's amazing I still have a tongue.

When we come in at three in the morning and we're sweaty and looking a little unkempt, it's extremely possible that we've done eighteen straight runs with barely enough time for a bathroom break.

If your vital signs don't line up exactly with ours keep in mind that ours are done with primarily a stethoscope and a manual bp cuff in the back of an ambulance with a Powerstroke diesel engine. I promise you we do the best we can.

When we ask you for a face sheet/billing sheet/charge sheet, it's not because we want to create more work for you. Particularly in the Nursing Homes. We need that information for our run reports and at least at my company, not having that information is grounds for a write up.

When I ask you at the Nursing home about your patient, it only benefits the patient if you can give me some history. I realize you are stretched thin, and that you might have to look through the patient's chart. Remember this helps the patient, it helps us as EMT's in the continuation of care, and it helps the ED Nurses when I transfer care to them.

A lot of EMS folks complain when you call us Ambulance Drivers. There's some truth to that title. We do, at times, drive an ambulance. That being said there's a skill set here that we have that you might be unaware of. We carry and utilize O2, monitors, defibrillators, vents, and suction. Paramedics can administer a number of drugs, including cardiac and narcotics. They can intubate, put in IV's, IO's and can even cric someone if it comes to that. Even though we drive an ambulance, it's unfair to lump us all into a group and label us “Ambulance Drivers”.

Finally, I realize there are some of us who are arrogant and cocky and who think of themselves as Gods. At least on the EMS side, the good EMT's and Medics... We want to knock those folks down a peg just as much as you do.

We're not Nurses. But we work just as hard as you do. We're out there in the trenches, in our patient's homes and sometimes even in that bar you would never set foot in doing our job. We're human and we care about our patients just as much as you do. We're someone's Wife, Husband, Mother and Father. Most of us respect the hell out of you for the job that you do, and a lot of us aspire to do that same job. Believe it or not, for the majority of us, our number one priority is our patient's well being. Sometimes that comes before our own well being, despite what we've been taught.

I hope that maybe I've given you a glimpse into a profession you may or may not have been familiar with.

All my best,



Medic61 said...

Truer words I couldn't have said. That was an awkwardly worded sentence. Point is: you're so right, and I loved this post.
I'm glad to formally meet the elephant, even though I've known him for a while now :)

Lin said...

You ARE sending this to Change of Shift, correct!?!

Very well thought out and presented. Great job of writing. And your "day" work is greatly appreciated by those who need it.
Thanks for all you do, Epi.

Evil Lunch Lady said...

Great post!

Bernice said...

*standing ovation*

david331.WamBamThAmbulance said...

I hope Mr. Elephant doesn't need to go to the E.R. I'm not sure I've got a nasal cannula that'd fit.

david mcmahon said...

You hit the nail on the head with this sentence:

At our core, we all want to help someone who needs it.

NJ EMS said...

Give em hell!!!!!!Love this post.

Rogue Medic said...

Excellent post.

If our vital signs do not match hospital vital signs, that does not mean that EMS does not know how to take vital signs. Sometimes it means that the patient's condition is changing, maybe as a response to EMS treatment, maybe in spite of EMS treatment. One thing I noticed after the switch to monitors with NIBP, if it is printed by the machine, a lot of the nurses automatically trust it. The machine is unthinking but automatic and so is this trust.

The billing demographic sheet is as important as any of the other information we deal with. Without it we are not likely to stay in the same job. I tend not to obtain this information until I get the paperwork from the hospital. I think it is much more important to have a good assessment and history, than the patient's social security number, age, and phone number. Treatment-wise, does it make a difference if the patient is 62 or 82?