EMS working in small hospitals, long term care

[emtannie]

As some of you are aware, the province has taken over ambulance services in Alberta.

In the region I work in, there has been a development that has many interesting twists and turns. In smaller rural communities with a small hospital and an ambulance service, AHS is implementing job description changes, where EMS staff are now required to work in hospital when not on a call, primarily in the long term care environment. This workload includes assisting long term care staff with dressing patients, moving patients from rooms to dining area or other area, assisting with exercise or physiotherapy, and potentially other duties. As EMS staff are required to be in the ambulance within 60 seconds of a call coming in, they are not to be involved in toileting or bathing patients, or being in a situation where they cannot leave immediately.

The EMS staff are also to work in the ER, under the supervision of the charge nurse in the ER, which right now means that medics cannot work to the full scope of their education, as here, a medic has a bigger scope of practice than a nurse does. Usually, there is not a doctor in the ER, as the doc is at the clinic, or just on call.

I am trying to be open-minded about this, as I do pick up casual shifts in a smaller community where this is being implemented, but I am having trouble with some of the politics and job descriptions.

At the site where I get a few casual shifts, when AHS took over EMS operations, the ambulance was moved back to the hospital from the fire hall. Nursing staff made it very clear that they did not want EMS in the hospital, and several went so far as to openly say “the ER is OUR domain, not yours.” Long term care staff alternate between “you are taking our jobs” and “why aren’t you here when we need you to be.” ER nurses have been very territorial, and several have been openly hostile to the medics. Originally, the medics were allowed to use their full scope of practice in the ER, but now they are not, due to complaints from the nursing staff about “EMS taking over.”

I am not sure what to think of these changes. I do know I did not get into EMS so I could work in long term care facilities. I worry that with changes like this, EMS skills will be diluted – there are several new EMT’s that work here, and I feel that their EMT skills are not as good as they could be – wouldn’t their time be better spent working on their EMS skills, rather than wheeling a LTC patient to the dining hall? Although there have been a few days where I have been able to work with staff where I learned new things, those days have been few and far between.

Several times, long term care staff have tried to get me to toilet or bathe a patient, and I have had to explain that I can’t be left alone with a patient in case my tones go. Although the EMS role has been explained to the staff, they still treat us like we are their employees, and many times when I have worked in long term care, the EMS staff have been left working with patients, while the long term care staff all go for coffee.

Personally, I think there has been too much catering to the egos of the nursing staff. EMS has valuable skills they can bring to a small ER, especially when the doctor is not at the hospital. I don’t think that the medics should have to wait for a docs orders in the ER, when if that patient was in the back of the ambulance, they wouldn’t have to. I don’t think EMS staff should be used as glorified personal care assistants in long term care.

I am not sure I like these changes – what do others think?

[mobey]

Sorry I can't add to your post, but it seems as though you are reading the book I wrote!

I think you need to copy and paste this post into word format and send it to your MLA.

[Happiness]

In BC they are trying to transfer the BCAS to the various health authorities (which are broke). It came to my attention that they were also trying to get us to do the same sort of things.... My response to the whole issue is this "If I wanted to be a nurse I would have gone to nursing school" I am lucky as this is not my bread and butter and if I have to I will say stuff it up your ass. I have a letter from my regional supervisor that says "Paramedics can chose to do hospital shifts but it will not be mandatory" I agree with Mobey get ahold of your MLA and what is the Union doing about this.....

[Just Plain Ruff]

It seems like with a shortage of people doing the menial work of the CNA and the like, that the province is looking at ways to augment the staffing of the long term care facilities and also the hospitals.

It's cheaper to pay a medic than it is to pay a nurse.

I "grew up" in a system that worked medics in the ER along with nurses. Worked pretty well but those nurses who worked with us knew that they would be working alongside medics when they were working so they had to decide if they could work with medics and those who took the job as a nurse in the ER took it knowing that medics were there.

It does sound like you are being used in a Scut capacity and that you need to evaluate what the job descriptions are from your province and go from there.

The nurses also need to be educated and briefed about medics in the ER. ER nurses hate change. They are probably feeling that their jobs are in jeopardy because if they can get a medic to do the job for less then they might just find themselves on the unemployment line and that is threatening to them.

Take a look at their perspective from this vantage point. You have always been working dual ALS crews and all of a sudden the province says that you have to use EMT's on your trucks, that would sort of be the same thing.

[mobey]

It's cheaper to pay a medic than it is to pay a nurse.

This used to be true, however the new Union Provincial agreement has medic wages starting at $29/hr to $40/hr with 2X overtime, and shift differentials up to $5/hr.

[Richard B the EMT]

Can anyone confirm or deny if this is just in Canadian areas, or if this is more international in scope?

[Timmy]

Certainly not a current trend in Australia...

[tniuqs]

At the site where I get a few casual shifts, when AHS took over EMS operations, the ambulance was moved back to the hospital from the fire hall. Nursing staff made it very clear that they did not want EMS in the hospital, and several went so far as to openly say “the ER is OUR domain, not yours.” Long term care staff alternate between “you are taking our jobs” and “why aren’t you here when we need you to be.” ER nurses have been very territorial, and several have been openly hostile to the medics. Originally, the medics were allowed to use their full scope of practice in the ER, but now they are not, due to complaints from the nursing staff about “EMS taking over.”

Agreed that AHS is stepping into very complicated areas of labour and medical legal issues under the guise of "improved utilization" again without doing their homework or putting into place good legislation before implementing a "dry run" to find out the problems of blanket changes ... just look to "dispatch problems" an Gene Z putting a "stop order" on that little issue.

I support the ACP in ER as this will be the future. That said: clearly deined roles and job description HAVE TO BE ON PAPER BEFORE ANY IMPLEMENTATION.

Some questions should to be asked:

1- So EMS can take a CNA / LPN job but not an ER RNs job, I guess one CAN have your cake and eat it too ? Curious ???

2- Is EMS is trained to provide long term care .. short answer NOPE. The priorities HAVE to be established first don't you think ? Besides that EMT/ Paramedic can not be in 2 places at one time, a 60 second to respond ... what if you are providing assistance in for a "bath" and get a call out ... leave the patient ? Hey were good but not THAT good.

Do you have clearly defined "job description" in this long term care facility as an EMT, or are you just the Head RNs bitch ?

Medical Legal

So just who is covering with the medical legal issues as in i.e. say if one drops a patient in Hospital? Has AB Health placed a a blanket insurance policy or have they even been asked ? Put request on paper for clarification it is your legal right to be informed.

The "past" medical legal under HDA the "local medical authority" ie the Medical Director were the undersigners ... following that and the transition to "the perfectly blended system" just who is signing off on local protocols and responsibilities lately ?

Can you as an EMT deliver oral meds or assist in IV therapy as that is within scope of practice for REMT or is one restricted just to lifting ? (NB. Back injuries are the biggest risk assessment for Workers Comp for EMS across the country and now the government is asking for more "lifting" ONLY ... hmmm interesting.

3- Agreed one MUST contact a local MLA concerning these new and improved Conservative Health Care incentives, there is an election comming soon AND the Conservative Party is attempting to keep the public happy and keep issues EXACTLY like this very quiet and out of the news, perhaps the local media should be contacted ?

ie NOT RUETERS

Local health care workers placed at odds over new incentive by Alberta Health.

4- Has HSAA been contacted ? So just where do they stand in all this, this is a change of job description and responsibilities.

5- "the ER is OUR domain, not yours" OMG it is ?

Firstly the ACP/ EMT-P working there "get a set" RN can not restrict scope of practice under the current legislation and the HOSPITAL is Public Property, so stand your ground based on what is the best practice model for the community !

If any one single RN has stated this in public they are in deep ca ca.

It sounds as if the whole concept is to use ACP to use their skills in the ER due lack of rural MDs. This is already an EPIC FAIL based on RNs territorialism AND NOT WHAT IS BEST FOR THE PATIENTS !

6- "Nursing staff made it very clear that they did not want EMS in the hospital" Ok since when does Nursing dictate what specialty services provides what services, perhaps contact the RNs regulatory body CARNA maybe a complaint is in order as well or grievance against any ONE individual that has voiced opposition to the improved delivery of care.

http://www.nurses.ab.ca/Carna/index.aspx

Look to code of conduct.

Excerpt from website (Public Domain)

Nursing Values and Responsibility Statements

7. In providing care, nurses should also respect and value the knowledge and perspectives of other health providers. They should actively collaborate and where possible seek appropriate consultations and referrals to other health team members in order to maximum health benefits to people.

8. Nurses should recognize the need to address organizational, social, economic and political factors influencing health. They should participate with their colleagues, professional associations, colleges and other groups to present nursing views in ways that are consistent with their professional role, responsibilities and capabilities and which are in the interests of the public.

http://www.nurses.ab.ca/Carna/index.aspx?WebStructureID=1212

RNs do not stand a hope in hell of any public support if this hits the media and IMHO thats where this should be headed if the goal is to be accomplished. btw (If anyone is afraid of job security ... I just may know an individual that is NOT employed by AHS and has been very OUTSPOKEN in these areas)

Or perhaps Contact Wild Rose Party about any concerns, as I believe they will be most pleased to open a dialog they have with that individual.

http://www.wildrosealliance.ca/

cheers

Late Entry ... just guess who my Wild Rose Constituency President:

Tim Essington REMT-P about time we got involved in our future.

Edited September 29, 2010 by tniuqs

[DartmouthDave]

Hello,

It seems that this 'intergration' has gotten of to a bad start. One thing I know for sure is cash strapped health authorities will try to push the envelope with patient to staff ratios, and staffing mix in order to save cash.

If done for the right reasons (i.e. not as work relief and as ad hoc staffing)medics in the hospital can be very benificial.

Change can be difficult. But, worth the trouble.

Here are two example that I know of as an excellent application of ACP in the hsopiatl setting.

---> Capital Health District (Halifax) uses ACP as triage at the QEII

---> The Cobequid Health Center in Sackville (NS) uses ACP for casting, sutures and as a part of the code team.

Cheers

Edited October 5, 2010 by DartmouthDave

[MedicAsh]

Annie,

I work for a hospital based ambulance. When we are not on the ambulance, we are in the ER, and if the ER is not busy, and the floor is, we go down there. It has its ups and downs. When working on the floor you are the (pardon my language) "floor nurses bitch". So you are doing everything they dont want to do. We get treated like CNAs that dont know crap. Granted there are some nurses who truly need help with things, but others sit and do nothing. If they have a patient that is one on one and they cant find a CNA guess who gets to sit with the patient, YEP EMS. Then they get pissy when we have a call and there is no one to sit with the patient. Dont get me wrong, I dont mind helping if they really need it, but when I am used to do their skut work because they want to sit on the internet and play on Ebay, I get a little pissed off. I also hate that I am getting in trouble for doing my REAL job on the ambulance when I have to leave a one on one patient.

I have to agree that I did not get into EMS to work as a CNA or nurse. If I wanted to do that I would be going into nursing. (Hence why I am going into Psychology). I am not even using skills down there. I get to do vitals...oooo big skills use there!!!! At least when we are in the ER, we are using skills. We can give meds and start IVs etc. On the floor we are skut monkeys and house keepers.

I guess it has its ups and downs working in the hospital like that. Some days I want to tell them where to go but other days it isnt bad because there is NOTHING going on.

Ok Ill stop babbling. Let me know if you have any questions (you are more likely to get me on facebook.)