The most difficult part of our job is the mental game we must play. While there are many players in this game, one of the most frustrating relationships we become involved in revolves around our interaction with emergency room personnel.

Nurse Ratched seems to be the one that always answers the med report and is there with a disheartening frown upon arrival to ask why you brought the patient to their facility. In all reality, does she really think that you will muster up some acceptable reason why you decided to ruin her night instead of taking your poor elderly patient that groans with every bump in the road to her facility instead of one that is 20 miles across town? While I'm often tempted to tell the nurse that I saw the vacancy sign on out front or that I told the patient Nurse Ratched's hospital is the best one when the patient asked me, I tend to just put on a smile and say the patient requested transport here.

If this struggle isn't bad enough, the normal response that my med report on the radio receives is to explain how long I must wait once i arrive and that I should transport elsewhere. I'm not certain why these responses and questions continue as they always end the same, with my arrival at their emergency room. I guess it makes them feel better or justified and anyone that knows me can vouch for the fact that I'm here to make the ER's life easier.

This battle of egos continues with my repeated requests for how long it will be for a room as I am ignored, being ignored by the receiving nurse while I'm giving her report after the patient is in their bed and then by the physician that wants to question my treatment when they have access to my protocol and are completely aware of what treatment we commonly provide.

Is there a reason that this game must continue? We have enough to do and enough pressure without having to play this game.

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This is a sign of a dysfunctional ED, with poor staff morale, etc.

Poor treatment of EMS medics arriving at an ED is an issues that should be addressed at the CEO level (hospital CEOs know that their most profitable patients arrive through the ED).  Your service chief and medical director should meet with the CEO of the hospital, discuss the problem, and develop a plan of action.  I have seen one community (a pretty large metro) where the triage nursing staff was, wholesale, transferred out of the ED because of this very issue.  If you belong to a labor organization, they can work on it too.  One thing for sure - this will not be solved by an individual medic.  This is an issue where high-level leadership is important.

Meanwhile, it takes two to play "this game."  Try killing them with pleasantness.  Call in your report, then turn the radio down and don't pay attention to the diatribe.  Greet the ED staff with a smile and don't ask (even once) how long it will be until you get a room.  If they can't get the satisfaction of seeing you react unhappily, it won't be "fun" any more.

Respect?  Let's review.

1. Nurse Ratched (which you used more than once in your post) or any of the other names used on these very public forums to refer to nurses says alot. It is very, very rare to see such derogatory names for Paramedics used on one of the largest and most popular nursing forums. Usually Paramedics are welcomed as professionals for their opinions. 

2. All nurses are "women". That pretty much sums up a very different type of attitude.

3. All ED nurses have to do is wait for a Paramedic to show up and nothing else.  

This battle of egos continues with my repeated requests for how long it will be for a room

4.  ED nurses do not make the decisions about the bed availability for the rest of the hospital. They can not tell an ICU Intensivist to throw out his or her critical patients to a lower level floor. They can not call in more staff for the short handed floors. 

 the physician that wants to question my treatment when they have access to my protocol and are completely aware of what treatment we commonly provide.

5. You want the doctor to "assume" every Paramedic follows the protocols exactly and gives the exact same treatment.  But, that statement also makes it sound like you definitely function totally by recipes which also might explain the attitude on both parts.

the normal response that my med report on the radio receives is to explain how long I must wait once i arrive and that I should transport elsewhere. I'm not certain why these responses and questions continue as they always end the same, with my arrival at their emergency room.

I put this under the protocols comment. Maybe the ED staff wants you to consider other options as to where to take the patient since YOU are looking directly at the patient and talking with them.  They have given you the information about their situation and you might need to see if you have other hospitals which might work out better for you and the patient.  

that I told the patient Nurse Ratched's hospital is the best one when the patient asked me, I tend to just put on a smile and say the patient requested transport here.

Here it sounds like you are doing what is best for you and not the patient. Now, it will be entered into the patient's chart as being requested for that hospital which may not go over very well if the patient has certain insurances. The patient might not even be aware that you have now made this as part of their permanent record.  As a patient I would be totally pissed if you said that for documentation.

If you walk in with a chip on your shoulder and looking to put all the blame on a nurse because you don't get milk and cookies with applause every time you walk through the door you make it difficult for anyone to take you seriously.

There are good and bad in every profession. One ED might see 20 - 100 ambulances easily in one 12 hour shift. We see the best and the very worst of patients and attitudes from Paramedics. You have seen one  female nurse Rached and now see all nurses to be like that.  We might see a dozen or more Ricky Rescues who just watched Chicago Fire or Trauma and now believe they are like a doctor only better since they do the same things only at 60 mph.  It gets old after awhile. 

The fragile egos even get hurt when some things like CMS, billing and legislative policy are discussed which everything comes across to you as every other health care profession is out to get you. 

Meanwhile, it takes two to play "this game." 

 

Not everything is a game and not every nurse is just messing with the Paramedics. If you teach your new Paramedics that the ED is just playing games without any real understanding of the situations that control patient movement within a system then you are continuing to fragment what should be a team.  Education is key on both parts.  Healthcare in the US is broken and one CEO isn't going to be able to fix it either. They are under fire now for all of the nurses and support staff they have had to layoff over the past few years. 

I welcome you to visit some of the nursing forums like allnurses.com to see if  nurses are continuously bashing Paramedics with such disrespect by derogatory names. But, to be clear, I for one do not believe ambulance driver to be a bad name. Considering how many EMTs and Paramedics we see in our OH department for substance screening and the scrutiny they go through for just a paint chip makes me wonder why the hell anyone would want to drive an ambulance. It is a heavy responsibility.

Nurse Ratched is used as a form of humor. If you take such offense, maybe you should not be trolling around on EMS forums and stick with all nurses.com where you will not have to see this term. It appears that you have quite the feminist attitude in regards to taking offense when a refer to a nurse as a woman. Is nursing not a female dominated field? Do we not refer to most soldiers as men since it is a male dominated career?

I'm quite aware that ER nurses are busy. We frequently see open beds, nurses sitting around chatting and the refusal to make eye contact upon arrival. When our tones drop, we don't continue to sit around eating or chatting, watching television. We get up and go to work. It is the ER staff's responsibility to manage patients at their facility. State and federal laws dictate that our care ceases upon arrival at their facility. No matter what the call is for, we will send a unit to respond regardless of the patient'ss complaint. Why should the hospital not maintain the standard of at least assessing their patients in a reasonable timeframe as well.

Regardless if I walk in with a chip on my shoulder or not, wether I walk in with a smile on my face or not, the response is frequently the same. As with many communities, our healthcare system is run by a monopoly. The same healthcare system owns all 4 hospitals here. We have protocol that dictates certain patients (orthopedic, neuro, cardiac, peds, ob, etc) can be transported to certain hospitals as most here are specialized. Unless the patient requests a hospital that doesn't offer a specific service they need, we transport to their requested destination as it is within their rights.

This poor attitude that ems is out trolling for patients and attempting to make the ER's job difficult was here before me and I'm certain will long outlast me. I'm sorry you guys are busy, but so are we. We're just doing our job and it doesn't need to be a battle.

Looking at some of your other discussions, Geri, it appears you are just here trying to see if you can ruffle a few feathers. Answer as you like, but I understand your mentality and I will not engage it any farther.

As always Skip says it best but I want to throw my 2 cents in.   I agree with everything he said and I can say I have been a part of that change.  It works.  If the ER staff does not want your business then talk to the management folks.  Im talking about the people who manage the money.  They DO want our business I can promise.  I agree with dont ask how long it will be before you get a room.  Who cares?  You get paid either way and its not worth your stress. If your ER wait times are high then your management should notice and move to change things.  I know of an agency that gave power at a low level to put a facility of diversion if the wait times were getting long.  If you talk to the management of the hospital and let them know that their hospital will be getting bypassed due to long ER wait times and the resulting drain on EMS resources they will light the proverbial fire under the ass of the ER management staff.  (looking back you said in your area all hospitals are owned by one company.  That being true there is STILL someone who manages that particular individual hospital who wants you to come there.) After this has happened all it takes is for you to let them hear you putting them on diversion or even better, go nicely talk to the charge nurse and find out what their status is.  How long is the estimate for a room?  Do they have a lot of ICU holds?  Are the long EMS wait times expected to continue?  If so how long?  If they know that you will be diverting business away from them and their CEO has told them to avoid this, they will work with you...  They still may not be able to give you a bed.  Just because there are open beds doesnt mean they have a nurse for that room.  Just like at a restaurant  if they are short on waitresses there are empty tables but no one to man them.  Anyway, if you must/need to divert away from that hospital so be it, no big deal.

Keep in mind that like Skip said, this is a sign that their moral is low.  It may be true that they are understaffed.  Dont let this be about respect.  Its just the way of lots of ERs :)  Bark and get barked at.  Its usually not really personal even if it seems that way.

Those who troll here will know that Geri and I rarely agree - but this time, she makes some valid points, as does Nathan.

The choice of screen name says a lot.  Methinks that there is a little low self-image issue going on here, who works for an agency that might not be "taking care of business" when it comes to the folks in the field.  Sounds like an "ambulance company" and not an "EMS system" with some leadership.


very nicely written
Geri Jacobson said:

Respect?  Let's review.

1. Nurse Ratched (which you used more than once in your post) or any of the other names used on these very public forums to refer to nurses says alot. It is very, very rare to see such derogatory names for Paramedics used on one of the largest and most popular nursing forums. Usually Paramedics are welcomed as professionals for their opinions. 

2. All nurses are "women". That pretty much sums up a very different type of attitude.

3. All ED nurses have to do is wait for a Paramedic to show up and nothing else.  

This battle of egos continues with my repeated requests for how long it will be for a room

4.  ED nurses do not make the decisions about the bed availability for the rest of the hospital. They can not tell an ICU Intensivist to throw out his or her critical patients to a lower level floor. They can not call in more staff for the short handed floors. 

 the physician that wants to question my treatment when they have access to my protocol and are completely aware of what treatment we commonly provide.

5. You want the doctor to "assume" every Paramedic follows the protocols exactly and gives the exact same treatment.  But, that statement also makes it sound like you definitely function totally by recipes which also might explain the attitude on both parts.

the normal response that my med report on the radio receives is to explain how long I must wait once i arrive and that I should transport elsewhere. I'm not certain why these responses and questions continue as they always end the same, with my arrival at their emergency room.

I put this under the protocols comment. Maybe the ED staff wants you to consider other options as to where to take the patient since YOU are looking directly at the patient and talking with them.  They have given you the information about their situation and you might need to see if you have other hospitals which might work out better for you and the patient.  

that I told the patient Nurse Ratched's hospital is the best one when the patient asked me, I tend to just put on a smile and say the patient requested transport here.

Here it sounds like you are doing what is best for you and not the patient. Now, it will be entered into the patient's chart as being requested for that hospital which may not go over very well if the patient has certain insurances. The patient might not even be aware that you have now made this as part of their permanent record.  As a patient I would be totally pissed if you said that for documentation.

If you walk in with a chip on your shoulder and looking to put all the blame on a nurse because you don't get milk and cookies with applause every time you walk through the door you make it difficult for anyone to take you seriously.

There are good and bad in every profession. One ED might see 20 - 100 ambulances easily in one 12 hour shift. We see the best and the very worst of patients and attitudes from Paramedics. You have seen one  female nurse Rached and now see all nurses to be like that.  We might see a dozen or more Ricky Rescues who just watched Chicago Fire or Trauma and now believe they are like a doctor only better since they do the same things only at 60 mph.  It gets old after awhile. 

The fragile egos even get hurt when some things like CMS, billing and legislative policy are discussed which everything comes across to you as every other health care profession is out to get you. 

Meanwhile, it takes two to play "this game." 

 

Not everything is a game and not every nurse is just messing with the Paramedics. If you teach your new Paramedics that the ED is just playing games without any real understanding of the situations that control patient movement within a system then you are continuing to fragment what should be a team.  Education is key on both parts.  Healthcare in the US is broken and one CEO isn't going to be able to fix it either. They are under fire now for all of the nurses and support staff they have had to layoff over the past few years. 

I welcome you to visit some of the nursing forums like allnurses.com to see if  nurses are continuously bashing Paramedics with such disrespect by derogatory names. But, to be clear, I for one do not believe ambulance driver to be a bad name. Considering how many EMTs and Paramedics we see in our OH department for substance screening and the scrutiny they go through for just a paint chip makes me wonder why the hell anyone would want to drive an ambulance. It is a heavy responsibility.

It seems to me that what matters most, patient care is being forgotten about here. It's great that those of us in health care & EMS are such passionate people, if you loose that then time to move on. Maybe trying to suggest to hospital management that you've identified a problem that relates to patient care & patient satisfaction & that you would like to work together with their organization to find & implement solutions.

I can see patient satisfaction being an issue here but not really patient care being an issue.   Could you elaborate?

Secondly, I agree patient care is what matters most, but in today's world what it all comes back to is money...  If you want to motivate the people who make things happen (the money managers) you have to speak that language..

Deborah Siegel said:

It seems to me that what matters most, patient care is being forgotten about here. It's great that those of us in health care & EMS are such passionate people, if you loose that then time to move on. Maybe trying to suggest to hospital management that you've identified a problem that relates to patient care & patient satisfaction & that you would like to work together with their organization to find & implement solutions.

It isn't clear how much of this involves "emergency room personnel," and how much involves a few interpersonal clashes. I suspect the latter.

I have posted on allnurses.com in the past (I was looking for ED nurses' perspectives on an issue), and I can agree with Geri that, in general, most ED RNs have a fairly good impression of EMS folks. Heck, I know a number of RNs who either got their start in EMS, or even continue to be involved.

Skip is also correct - an ED that has it's head screwed on straight wants your business, and should be figuring out ways to lure you in, not discourage you!

I don't want to cut on anyone and the role that they play in people's lives but I do want to say that I personally know many nurses who think that those of us in EMS are not professional and that we are not qualified to do what we do! I have been told that people die because of us, I think that nurses are great and I'm glad that they do what they do, but those of us that are out in the cold at 3 a.m. doing what we love should also have that same respect given back.

I also just want to throw this out there, but I really hate the term ambulance driver, there is so much more to what we do than that!



Deborah Siegel said:


very nicely written
Geri Jacobson said:

Respect?  Let's review.

1. Nurse Ratched (which you used more than once in your post) or any of the other names used on these very public forums to refer to nurses says alot. It is very, very rare to see such derogatory names for Paramedics used on one of the largest and most popular nursing forums. Usually Paramedics are welcomed as professionals for their opinions. 

2. All nurses are "women". That pretty much sums up a very different type of attitude.

3. All ED nurses have to do is wait for a Paramedic to show up and nothing else.  

This battle of egos continues with my repeated requests for how long it will be for a room

4.  ED nurses do not make the decisions about the bed availability for the rest of the hospital. They can not tell an ICU Intensivist to throw out his or her critical patients to a lower level floor. They can not call in more staff for the short handed floors. 

 the physician that wants to question my treatment when they have access to my protocol and are completely aware of what treatment we commonly provide.

5. You want the doctor to "assume" every Paramedic follows the protocols exactly and gives the exact same treatment.  But, that statement also makes it sound like you definitely function totally by recipes which also might explain the attitude on both parts.

the normal response that my med report on the radio receives is to explain how long I must wait once i arrive and that I should transport elsewhere. I'm not certain why these responses and questions continue as they always end the same, with my arrival at their emergency room.

I put this under the protocols comment. Maybe the ED staff wants you to consider other options as to where to take the patient since YOU are looking directly at the patient and talking with them.  They have given you the information about their situation and you might need to see if you have other hospitals which might work out better for you and the patient.  

that I told the patient Nurse Ratched's hospital is the best one when the patient asked me, I tend to just put on a smile and say the patient requested transport here.

Here it sounds like you are doing what is best for you and not the patient. Now, it will be entered into the patient's chart as being requested for that hospital which may not go over very well if the patient has certain insurances. The patient might not even be aware that you have now made this as part of their permanent record.  As a patient I would be totally pissed if you said that for documentation.

If you walk in with a chip on your shoulder and looking to put all the blame on a nurse because you don't get milk and cookies with applause every time you walk through the door you make it difficult for anyone to take you seriously.

There are good and bad in every profession. One ED might see 20 - 100 ambulances easily in one 12 hour shift. We see the best and the very worst of patients and attitudes from Paramedics. You have seen one  female nurse Rached and now see all nurses to be like that.  We might see a dozen or more Ricky Rescues who just watched Chicago Fire or Trauma and now believe they are like a doctor only better since they do the same things only at 60 mph.  It gets old after awhile. 

The fragile egos even get hurt when some things like CMS, billing and legislative policy are discussed which everything comes across to you as every other health care profession is out to get you. 

Meanwhile, it takes two to play "this game." 

 

Not everything is a game and not every nurse is just messing with the Paramedics. If you teach your new Paramedics that the ED is just playing games without any real understanding of the situations that control patient movement within a system then you are continuing to fragment what should be a team.  Education is key on both parts.  Healthcare in the US is broken and one CEO isn't going to be able to fix it either. They are under fire now for all of the nurses and support staff they have had to layoff over the past few years. 

I welcome you to visit some of the nursing forums like allnurses.com to see if  nurses are continuously bashing Paramedics with such disrespect by derogatory names. But, to be clear, I for one do not believe ambulance driver to be a bad name. Considering how many EMTs and Paramedics we see in our OH department for substance screening and the scrutiny they go through for just a paint chip makes me wonder why the hell anyone would want to drive an ambulance. It is a heavy responsibility.

I generally agree with you, Leigh, but (particularly going back to the beginning of this thread) there are way too many folks in EMS who demonstrate lack of professionalism to ED staffs and others every day.  If all we are concerned about is ourselves, that shows, and other health care professionals (who have been trained from day one to be "patient centered" don't respect that.  They also don't respect our opposition to education - particularly enough education do to what we do safely and effectively.  In other professions, they call "doing stuff" without sufficient education and training "dangerous" and "irresponsible" - and they generally don't allow it.

I know of way too many "paramedics" who, the first time they intubate a patient, they do it in an uncontrolled, unsupervised environment, where the patient "takes their chances" on the skill of the provider.  A responsible profession wouldn't allow that.

I agree with Skip Kirkwood's reply, as medics we must show the rest of the helth care feild care givers what we are made of. To show the nurses that we are frustrated with the off load times and act poorly only compounds the issues at hand. Currently in my home province, there is long offload delays as well. Not only are the medics/nurses and doctors frustrated, but so are the pt's. I find to get a positive response from receiving staff at the hospital, a proper attitude from the medics is required upon arrival. Not to say that a critically injuried/sick pt will wait in the hallways, but those pt's that must wait, proper edicate is a requirement. Even with the most irretable receiving nurse at the dest, you catch more flys with honey then bullshit is the key.

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