Difficulty With a Nurse

[Eydawn]

Help! The wreckless wontons are going to get us! They've already blown up three Chinese restaurants...

I think you meant "reckless wanton".... and it was too funny to pass up!

Wendy

CO EMT-B

[zippyRN]

the ANA says

http://www.nursingworld.org/MainMenuCatego...Regulation.aspx

"The registered nurse’s practice flows through several levels of accountability in order to ensure safe competent practice. At the base of this pyramid of accountability is the Scope and Standards of Nursing Practice, developed and vetted by ANA on behalf of the profession. The Scope and Standards create the foundation for specialty practice standards and inform the State Nurse Practice Acts, which provide a second layer of accountability. Rules and regulations promulgated by individual states, based upon each state’s nurse practice act, may restrict the RN’s practice. Further restrictions upon practice occur because of the nurse’s accountability to the institution or agency for whom she/he employed, via institutional policies and procedures. A final level of accountability for RN practice occurs via the individual nurse’s own self-determination of those aspects of practice she/he believes herself competent to perform. "

as a random example from a Nurse practice act

http://www.arsbn.org/pdfs/NURSEPRACTICEACT_2007__5_.pdf

"(6) “Practice of professional nursing” means the performance for compensation of any acts involving:

(A) The observation, care, and counsel of the ill, injured, or infirm;

( The maintenance of health or prevention of illness of others;

© The supervision and teaching of other personnel;

(D) The delegation of certain nursing practices to other personnel as set forth in regulations established by the board; or

(E) The administration of medications and treatments as prescribed by practitioners authorized to prescribe and treat in accordance with state law where such acts require substantial specialized judgment and skill based on knowledge and application of the principles of biological, physical, and social sciences; ...

(8)(A) “Practice of registered nurse practitioner nursing” means the delivery of health care services for compensation

in collaboration with and under the direction of a licensed physician or under the direction of protocols developed with a licensed physician.

( Nurses shall be authorized to engage in activities as recognized by the nursing profession and as authorized by the board.

© Nothing in this subdivision (8) is to be deemed to limit a registered nurse practitioner from engaging in those activities which normally constitute the practice of nursing, or those which may be performed by persons without the necessity of the license to practice medicine.

17-87-103. Exceptions.

This chapter does not prohibit:

(1) The furnishing of nursing assistance in an emergency;

(2) The practice of nursing that is incidental to their program of study by students enrolled in nursing education programs approved by the board;

(3) The practice of any legally qualified nurse of another state who is employed by the United States Government or any bureau, division, or agency while in the discharge of his or her official duties in installations where jurisdiction has been ceded by the State of Arkansas;

(4) The practice of any legally qualified and licensed nurse of another state, territory, or foreign country whose responsibilities include transporting patients into, out of, oror through this state while actively engaged in patient transport, that does not exceed forty-eight (48) hours in this state;

position paper from the same board of nursing

"3. The delivery of healthcare services which require assessment, diagnosis, intervention, and evaluation fall within the professional nurse scope of practice. ...

5. The nursing decision to carry out a health care act should always include consideration of:

A. Degree of immediate risk to the client if the action is not carried out when

appropriate professional personnel are absent.

B. The overall complexity of the client's healthcare problem.

C. The degree of invasiveness of the act. The more invasive into the anatomical or

physiological integrity of a client a task or activity is, the greater the liability of the

nurse and the greater the risk to the public.

D. The reversibility of the action.

E. Prompt access to medical support.

F. The nurse's ability to prove by documentation and appropriate knowledge and skill

base that the nurse is competent to perform the act.

plus of course the NCBSN says

https://www.ncsbn.org/NursingRegandInterpretationofSoP.pdf

"Practice areas of different health care professionals are not exclusive: there are numerous overlapping areas and activities that constitute the practice of nursing when performed by a nurse and the practice of another profession when performed by another licensed healthcare professional. What is unique for nurses is the configuration and breadth of nursing practice, both independent aspects of practice and the implementation of health regimens prescribed by other authorized providers."

[WelshMedic]

Zippy,

Do you see the link between the following two statements?

An ER nurse with no prehospital experience or training, barking orders on an accident scene or other; prehospital setting is silliness.

A final level of accountability for RN practice occurs via the individual nurse’s own self-determination of those aspects of practice she/he believes herself competent to perform.

It's a shame that some people are not aware of the limitations in their capabilities. If I were the provider on scene and you dealt with me in the same way that you deal with your (virtual) colleagues on this forum then I, too, would have you immediately removed.

Why do you insist on turning everything into a pissing contest? I'm sure it is a form of frustration. You are obviously a resonably intelligent person and so I'm left wondering why you, instead of becoming increasingly frustrated, don't choose for a career change and join EMS?

I'm not sure whether you realise it, but you just confirm the image that some here have of our profession that is stated in the opening message on this topic.

I am sure that your not at all like this in real life (well, I hope not anyway), so why do you insist in giving our profession a bad name when it comes to interprofessional relationships? It doesn't matter who you are in the chain, we are all important. If it weren't for the cleaners at your hospital you'd still be polishing the floors just like our colleagues did in the first half of the last century.

Which speciality do you work in anyway?

WM

PS -This is meant as good advice, not a opening to attack me, by the way...

[WelshMedic]

OK, that's my take on the Zippy situation dealt with.....so now I'll move on to my thoughts on the original subject matter.

For starters, I have problems with the title. It should have read: "Difficulties with other healthcare providers" Nurses are just a part of the team and as already has been stated here: there are plenty of HCP's that need to take communications skills 101. It's across the board, so don't just tar nurses. We are just as individual as any other group.

But why does this occur? Well, I once had a colleague in the ER that had a background in psych. nursing. He was a real people watcher...fascinating. Here's his theory on the subject (I could claim it as mine, but I'm far too honest ):

Certain personality profiles are attracted to the acute specialities in healthcare, let's just say, "the adrenaline junkies". These people often have quite strong characters and are, generally, not easy to walk over. This has it's benefit's: you can be sure that these people have the self-confidence to deal with a stressful situation. However, it also has it's downfalls: the same people are strong willed and are more likely to become involved in a conflict. And therein lies the problem, if something does not please us then we are apt to start a war to solve it.

Just my take on this, I'd be interested to hear other's views on this subject.

WM

[zippyRN]

Zippy,

Do you see the link between the following two statements?

yes i do and the upshot of it is that do not assume that Nurses are incapable of practice in pre-hospital care

It's a shame that some people are not aware of the limitations in their capabilities. If I were the provider on scene and you dealt with me in the same way that you deal with your (virtual) colleagues on this forum then I, too, would have you immediately removed.

good job you don't have NMC or HPC registration ... becasue potentially it;s you that faces the professional discipline ...

Why do you insist on turning everything into a pissing contest? I'm sure it is a form of frustration. You are obviously a resonably intelligent person and so I'm left wondering why you, instead of becoming increasingly frustrated, don't choose for a career change and join EMS?

no it;s not, it's about working together , some of utter rubbish talked aobut Health professionals on this forum cannot and should not go unchecked...

I'm not sure whether you realise it, but you just confirm the image that some here have of our profession that is stated in the opening message on this topic.

I am sure that your not at all like this in real life (well, I hope not anyway), so why do you insist in giving our profession a bad name when it comes to interprofessional relationships?

why 's that - becasue i don't roll over and let one staff group continuously libel awhole other professions?

It doesn't matter who you are in the chain, we are all important. If it weren't for the cleaners at your hospital you'd still be polishing the floors just like our colleagues did in the first half of the last century.

the significant factor is your position i nthe chain is important on the basis who who you carry the can for and the issues of transfer of care and having accountability for the actions of others when you do transfer care.

Which speciality do you work in anyway?

Emergency care , both in and out of hospital

WM

PS -This is meant as good advice, not a opening to attack me, by the way...

[WelshMedic]

yes i do and the upshot of it is that do not assume that Nurses are incapable of practice in pre-hospital care

That surely cannot be directed at me........ the point was that, by virtue of an RN ticket, a nurse is not necessarily placed above an EMT of whatever level.

good job you don't have NMC or HPC registration ... becasue potentially it;s you that faces the professional discipline ...

I was NMC registered between 1991 and 2000, I see nothing in my comment that leaves me open to discipline. You really need to clarify that one to me.

no it;s not, it's about working together , some of utter rubbish talked aobut Health professionals on this forum cannot and should not go unchecked...

Yes, I couldn't agree more; that's why I replied to your post.....

why 's that - becasue i don't roll over and let one staff group continuously libel awhole other professions?

Pot, Kettle, black, ringing any bells here?

Did I not say that it wasn't personal and that I wasn't looking to continue the pissing match?

But it's OK Zippy, spend all you time and effort trying to out -quote me. I hope it makes you feel happy m8.

WM

[firespec35]

To the original poster sorry about your luck bro. Life sucks some nurses are bitches I hope you don't have to go there often. If it gets that bad make a formal complaint.

To the poster who had the nurses brother as a patient- Personally I would have told her to get the hell out of my truck. If she won't have her arrested when you get to the ER.

To zippy- I don't profess to know what goes on on your side of the world so I can't speak to that but here's how it goes in my little peice of the world.

It's all about respect. I respect the nurses I turn over to at the many hospitals I have to go to in the metro Detroit area. If I like you I will find little ways to make your life easier. It goes a long way, but I expect that respect reciprocated after a while of getting to know me and usually it is.

If you are off duty, you are not able to practice without some sort of organization backing you. The saying here is a medic isn't a medic without an ALS truck and the same goes for nurses. They can't operate to their level without some sort of backing. If you are off duty and come up on one of my scenes and haven't been drinking (I gotta evaluate for this, most of my scenes are at special events that serve alcohol) as long as you offer to help and arent demanding then usually I let you do something for me (hold the stretcher, carry a bag ect...) sorry bro it's my ass I will do all the advanced treatment. If you are demanding, overbearing, drunk ect... I will have you removed. Legally I don't have to turn my scene over to an off duty Doc unless he comes to the ER and Med control agrees. For Detroit East Med Control I'm pretty sure the only ones they would leave the scene with would be an ER doc or a Trauma surgeon, maybe a cardiologist if it was a cardiac call. So the point is zippy, there is a pretty big fall from that high horse of yours. You might want to find a rope ladder and join the rest of us on Earth.

[firedoc5]

For starters, I have problems with the title. It should have read: "Difficulties with other healthcare providers"

I believe the first sentence of the first post covers that.

:study:

Quote: "Has anyone ever had difficulty with a nurse or other medical staff?"

[WelshMedic]

FireDoc,

I take on you point, but I was purely referring to the title. The title is, after all, the first thing anyone will notice. And that is what I objected to. What happened as a result of the title? People proceeded to regale horror stories about nurses. I'm not knocking the authenticity of these stories, I just find it a little unbalanced.

There are good and bad in all professions....we can't be categorized as good or bad in terms of a whole profession.

WM

WM

[firedoc5]

FireDoc,

I take on you point, but I was purely referring to the title. The title is, after all, the first thing anyone will notice. And that is what I objected to. What happened as a result of the title? People proceeded to regale horror stories about nurses. I'm not knocking the authenticity of these stories, I just find it a little unbalanced.

There are good and bad in all professions....we can't be categorized as good or bad in terms of a whole profession.

WM

WM

I knew what you meant. I didn't take offense. When I wrote the first post I thought that would sufficiently cover the other professions other than nursing.

When I first posted the topic I didn't realize things would get so deep. It just started ballooning quickly. It's not a problem that it did, but I was just surprised. Guess I opened a can of worms. :?