nurses AND medics not nurses vs. medics

[Nick Nudell <paramednick@comcast.net>]

I am crossposting this reply from the flightweb list as I think it is
applicable to all the discussions on the subject.


You know what my ex partner who was an ex-Lt. with Chicago FD used to say
about that department?

"151 Years of Tradition unimpeded by progress".

Change has to come from within, not from the outside. I would say that this
only is NOT true in a few exceptions. It takes a certain personality and
approach to be able to demonstrate the need for a change, when it comes from
the outside. This particular attribute is not something often found in EMS.
Change is probably the most difficult thing for anyone person or group to
do. You have to be willing to change. The next question becomes, what is it
that needs to be changed and why.

Come to think of it, it is not hard to understand why EMSrs have difficulty
with change. With EMSrs facing a barrage of questioning (Monday night
quarterbacks) starting from on scene with other providers, to transport in
giving report, to arrival at the ED, to report giving at ED, to supervisors
and partners after the call, to the QI board and perhaps the hospital review
board and then the final opportunity being given to the Medical Director.
This type of approach tends to lend itself to the EMSr being very defensive
about his/her care. That is not really a surprise. This also leads to them
being very 'confident' about the decisions that have been made in their
care, as in it being the best thing to have done at the time.

For those that do not work in the field and have ample time and opportunity
to check and recheck orders prior to carrying them out, 'small' errors in
judgment may look like glaring errors. When someone with 12 years or more of
education (plus upteen years of experience) is creating an order, then
someone with 4 years of education (plus umpteen years of experience) is
checking the order and has time to gather the items/drugs to carry it out,
mistakes are easily caught. In the field, you do not have time to think,
rethink, recheck, rethink and carry it out. The other threads being
discussed on the other lists point this out (minimize scene times and
perform interventions before you arrive at the hospital). Prior to treating
in the field, one initial assessment is performed (generally). In the
hospital there are at least three (triage/EMS, nursing assessment, physician
assessment and maybe RT assessment) and perhaps even some lab work or
radiological study. I have caught errors made by all concerned in the
hospital before, so even with all this checking and rechecking errors still
occur although it is much less frequent. This could lead to those in the
more protected environment becoming more critical of those that function in
a less protected environment.

Notice, I did not use any terminology to specify specific job titles. This
is because they all may be found in both environments. Nurses make the same
mistakes as paramedics, when they work in the field. Paramedics make the
same mistakes as nurses, when they work in the hospital.

The difference comes from the way it is handled in the particular
environment. The flight nurses are much more sympathetic to paramedicine in
most regards (generally) then the hospital nurses. Paramedics who work in
the hospital also I believe have a more sympathetic or perhaps an empathetic
understanding of nurses. Nobody has much of an understanding of what
happens, or why, in long term care facilities when we see myriads of
patients from those places who have been treated ( or not) like they are but
that is an entirely different thread.

So, all the posts seem to approach one common theme...Attitudes... from
everyone involved.

How do you change a predisposed attitude? Can you change it? Should you?
How? Why?

Nick


____________________________________________
Nick Nudell, NREMT-P, CCEMT-P
California
nudell@prehospital-perspective.com

"Perception is reality" - Wise Old Paramedic




----- Original Message ----- 
From: "Patrick Cobb" <pcobb@wilcoems.org>
To: <flightmed@flightweb.com>
Sent: Friday, May 02, 2003 6:49 PM
Subject: re:nurses vs. medics


> This has been an interesting discussion over the obvious
discrepancies.However, one topic has not surfaced that I attribute to the
problem; TIME.The first nursing journal was published in 1886.Obviously,
nursing has been around for many years before the invention of formally
trained pre-hospital providers.I believe Paramedicine is still fighting a
big demon; TRADITION.In the beginning of Paramedicine, we were taught the
basics.Just enough to provide minimal care to patients and hope they get to
the hospital alive.That is the way some of the nursing profession still
views our role in patient care.Obviously, this is a very general
statement.But consider this, how many Paramedics go thru hospital clinicals
as part of their training process versus the number of nurses who go thru
field clinicals with us.We all know the answer-not very many.If we as a
profession took more time to educate the nursing students, we would have a
much easier time in helping the nursing field understand just ex
>
> Patrick N. Cobb, EMT-P, EMD
>
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