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Friday, August 28, 2009

I'm not an ER nurse...but I'm not an idiot.

After thinking it over I have decided that the poor relationship between RNs at sub acute care centers and EMTs is largely due to a lack of understanding about each other's jobs.

I am not an ER nurse. And this is not an ER. It's not even a hospital. We don't have suction at bedside, we don't have wall oxygen and we don't even have the equipment to start IVs never mind a med room full of fluids and STAT meds.

My job as a respite nurse in acute situations is a nursing assessment. My assessment is backed by four years of training, three of experience, knowledge of individual patient medical history and of this patient population in general and my own gut. Then I weigh in my assessment against my knowledge of our facility's capabilities and protocols. It's a simple algorithm and I have illustrated it here:

As you can see, unfortunately for EMTs sometimes we have to call on them for non emergency transport. If the situation is urgent but not a time sensitive emergency, there isn't really another choice.

EMTs are more useful in an actual emergency than I am. If I had an emergency I'd want EMTs there over most nonemergency medical personnel. Seriously.

But just because you are good at your job doesn't mean I'm not good at my job.

Calling emergency personnel in to help does not mean that I am stupid, panicky, lazy, or haven't done my job to the fullest detail. It means that I have come to the conclusion that this is the best plan of care for this individual patient during this unique situation. If I could just wheel patients to the ER myself and hook them up I would. This patient isn't coding. He's conscious and alert. He just needs an ECG/ IV fluids/ a bladder scan/ whatever. But those things are not part of my job. Just like knowing how to safely detox a diabetic heroin addict with a non healing foot ulcer over the course of five days is not part of an EMT's job. But one way or another, it all has to get done.

When everyone does their jobs to the best of their ability without thinking that they have the monopoly on the most important one, patient care is at its best.

That's my last entry on this for a while. I promise.

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