lazy nurse or maybe clueless

[tamaith]

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?

[chbare]

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?

So, while you were laughing, did you ever consider the differentials for syncope? Quite a list, being that syncopal episodes in many cases do not simply occur. In some cases there is actually a cause. While I agree, it is a real treat hounding on nurses, you may need to look at your own practice.

I guess we can add this to the capacious list of threads about nurses who mess up. I am not sure what good will come out of another EMS versus nurse debate; however, I have been proven wrong in the past.

Take care,

chbare.

[tamaith]

yes i know that there are different reasons for sycnope and not every one is caused by the same thing. could be epilepsy , tia, hypoglycemia etc. i was laughing cause pt had a history of synocpe that s the reason why the pt is in the nusing home. that is what was written on the piece of paper (transfer sheet) the nurse wrote up. but if somone goes unrepsonsive for 60 seconds wouldn't you mention that the pt has a history of syncope? and don't get me wrong i mess up too Lord knows im not perfect nowhere close. but to me that just seems like really important info. just a frustrating day.

[VentMedic]

yes i know that there are different reasons for sycnope and not every one is caused by the same thing. could be epilepsy , tia, hypoglycemia etc. i was laughing cause pt had a history of synocpe that s the reason why the pt is in the nusing home. that is what was written on the piece of paper (transfer sheet) the nurse wrote up. but if somone goes unrepsonsive for 60 seconds wouldn't you mention that the pt has a history of syncope? and don't get me wrong i mess up too Lord knows im not perfect nowhere close. but to me that just seems like really important info. just a frustrating day.

Syncope?

Define "unresponsive". That could mean many things especially for a patient in the NH. Was he not able to speak but awake? Was it just a blank stare? Unresponsive to what type of stimuli?

The fact that the patient has A-Fib may or may not be pertinent depending on whether it is controlled. I know a co-worker who has had A-Fib since he was 25 y/o (20 years ago) after a bacterial infection and sometimes forgets to list it on his medical hx.

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

partner now pretty much screaming hey can someone help over here who is better than me.

For the dialysis patient, you had a critical patient on your stretcher and YOU didn't call the ED to announce you were on your way?

I think I would seek out a better way to communicate with this ED rather than just standing there screaming.

on 3lpm of compressed air via n.c.

Why would they even have compressed air in a dialyis center or flow meters that run on compressed air? Did you at least switch them over to O2?

What care did you provide to the patient on the way to the ED?

Let's have a better and more productive discussion focusing on what you could do for each of these patients or what you might have done differently.

Edited August 28, 2009 by VentMedic

[FireMedic65]

I'm going to have to agree with chbare and vent on this. So, instead of retyping up what they mentioned in my own words I will spare you the hassle of reading it all over again.

First of all though, what kind of "nurse" are we talking about? Every time I have been to the NH, I rarely even see an RN.

As for the doctor, most are so high and mighty with non smelling poops, they don't even bat an eye to listen to what a "lowly EMT" has to say. Either that, or it wasn't "their patient" and they don't want to get involved.

And yes, these things happen a lot sadly. I could tell stories all day about stuff like this. For example, the nurse who gave the diabetic water and was stumped as of why their sugar was so low.

[tamaith]

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.

[letmesleep]

The NH pt has me wondering.......were they unresponsive or just ignoring the "RN" that is in question? Seen it, love it! Just tossing that out there to be chewed on.

As far as the ER situation, why did it take a Doc to notice that your pt had coded on YOUR stretcher? I'm going to side with the others here, maybe the "screaming" tactics were NOT the best way to get your pt the care they obviously needed. WE need to work with the ER staff for the betterment of the pts. find another way to communicate both en route, and standing at that door. This may actually get you a lot further than the way things are being done. Effect change, and the respect level will follow, maybe instead of getting laughed at (asking about the I.N.R), they may educate you upon request.

just some thoughts!

[tamaith]

ok my partner wasnt actually screaming at the e.r. staff while asking for help. we walked in. they saw us. ignored us. we waited for about a min. asked for help.( pt is now unresponsive.). they looked at us. ask for help again. no one paid attention. asked for help. person on the phone said charge nurse is on the way. partner could not get a pulse . now raising his voice . but still not screaming. asking for help. finally a doc from across the e.r. was walking over and ask what we had. he couldn't get a pulse. he yelled code. and thats when evryone started paying attention. it might not seem like it. but we have nothing but respect for the staff that work in the e.r's all around the world. again just frustrated maybe its my lack of e.r. runs but i just don't understand why one doctor would look over at us then just ignore us. while we are trying get the pt to wake up.

as for the inr. thing that was at dialysis. it was the rn at dialysis who just walked away. and we asked the rn very politely /respectfully. the one nurse at the e.r. was great though she explained what inr was and told us that there was no way of us knowing what inr was since we are basics and that we did good since we asked and not pretend like we knew what the r.n. at dialysis was talking about.

[VentMedic]

finally a doc from across the e.r. was walking over and ask what we had. he couldn't get a pulse. he yelled code. and thats when evryone started paying attention.

partner could not get a pulse . now raising his voice

Forget the INR thing or what the RNs did or didn't do for now and get back to the ABCs. Both of these calls are good learning experiences for your own knowledge and you will run into these situations again in less controlled environments.

When did the patient stop breathing? Were you assisting the patient's respirations? Did either you or your partner initiate CPR? That will sometimes attract the attention of others. What treatment did you do enroute to the hospital? What were the last set of vitals? How long did it take you to go from the dialysis center to the ED? Would this patient have benefited from a Paramedic transport?

Edited August 28, 2009 by VentMedic

[tniuqs]

Yikes some harsh comments from the elder crowd on this thread ... lets not eat our young, perhaps a bit of over reading between the lines and to the other elders may be there is just some frustration and ranting here, shucks sometimes posts are just good release.

'tamaith' date='Aug 27 2009, 06:27 PM' post='222324']

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.

Ok cool after many years humping stretchers I enjoy the dialysis type run btw a good explanation of your back ground thing is capitalization and paragraphs are important and not that we have NOT picked up what you are presenting, you are presenting a situation that is by far not uncommon and clearly identify your issue.

I am not going to shred your presentation because I hear what your saying but don't forget that understanding other HCP are performing to the best of their training and accept they may be limited, part of EMS is maturity, yup and understanding limitations, of others and not to say that the others are making good points either. I digress.

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?

WOW you were presented with an excellent teaching opportunity, so did you do the best job you could do? hey promote the profession, heck a lot of EMT Bs I know would not even put on a monitor so kudos, let alone recognize A Fib a good catch, but little subliminal teaching because that it goes a long way ..... just saying.

Soo Just Think of working in a set route like in a LTCNH and suddenly BLAM an RN or any care giver with some with serious personal ties, like feeding, clothing daily and shooting the breeze with a patient/ friend then suddenly presented with a patient whom "they may" or may even not know" that needs far more attention than they needed before ... just saying, maybe a bit of adrenalin going ?

I like talking through a situation because a relaxed health care provider (no matter what level) always provides the better history, smile don't laugh.

2nd call

<snip> my point here is why couldn't the nurse at dialysis tell us what inr was? lazy? anybody have experiences like this before?

Even if they knew INR (from 3 weeks ago typically) would it really may a difference to outcome ?

Query and hit the books ... can one reverse Coumadin ? it is after all basically RAT poison.

Yes some people die, some care givers in NH are way too busy to actually know what is in the cup of meds they hand out daily, thing is our geriatric population is so over medicated its shameful and well documented too, so is it the nurses fault ... short answer (fill in the blank)

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

Forget the INR thing or what the RNs did or didn't do for now and get back to the ABCs. Both of these calls are good learning experiences for your own knowledge and you will run into these situations again in less controlled environments.

When did the patient stop breathing? Were you assisting the patient's respirations? Did either you or your partner initiate CPR? That will sometimes attract the attention of others. What treatment did you do enroute to the hospital? What were the last set of vitals? How long did it take you to go from the dialysis center to the ED? Would this patient have benefited from a Paramedic transport?

Dang you VENT I am always late and a Dollar short !