tRNfkatAMN and Flames a Flyin’

I am so proud of myself!

The first EMS Ethics post I wrote a few days ago “EMS Politics, Medical Ethics, and What Would You do?” the one with the ethical dilemma to cric or not to cric, gathered me my first comment flame!

The commenter, who bills himself as “The RN: formerly known as the Angry Male Nurse (or angry “murse” for the uninitiated) was pretty darn critical of me for writing what I did. Angry to the point of calling it a “masturbatory lifesaving fantasy” I might add.

And I thought that nobody was listening… Even someone who posts under an avatar of Jesus wearing shades.

So I started to write a comment back to him, and figured that I’d use it as my post for the day. Since I’m not intending to single this guy out and pick on him, and in fact, I honestly appreciate the fact that he took the time to add to the conversation: Here’s a link to his blog – http://nursinghole.blogspot.com. I encourage people to “call me a bonehead” as it says somewhere on my front page. Really, dissent is good and I’m not always right. So Mr. Angry RN, or heck… here’s what I’ll call you: tRNfkatAMN… You get the prize of a front page link and attention on my blog. A whole post in fact.

I get it. I picked on the nurse in the scenario. Yes, I did and I admit it. But, as you said on the last post on your blog, there’s a reason to pick on nurses and you illustrate that quite well in what I read from you. I will add that there’s often a lot of reason to pick on paramedics for the same issues. Not all nurses are good, not all paramedics are good. However, in response to your “I know it’s hard in a jam and on a moving rig, but let’s call a spade a spade comment” I’d say that I have about as much business commenting on the work of a floor nurse as you do commenting on what it is that I do. Just today I responded on an engine company, dug my way into a very crumpled SUV with hydraulic tools, and then treated and assessed a crumpled up patient. I was able to start two IVs, splint a probable neck and pelvis fracture, support breathing through his progressively worsening dyspnea, and complete a detailed assessment while sitting in the passenger seat of a really, really smashed vehicle. No other healthcare provider does that. Your patients may crash, but they don’t crash in a ditch, in the rain, at night. You’ve got a whole team of people and physicians standing by you, I’ve got me and my judgment.

But let’s color that statement by saying that I only had one patient assigned to me, and that my job, and in fact my only job, is acute care. I didn’t have the needs of multiple chronically and acutely ill inpatients resting on my shoulders. I did what I am supposed to do, focus “shotgun” medical care on my one patient at the time when he was most acutely ill. I didn’t have to manage a floor full of needs like you do in your job. I don’t want to either, that’s why I became a paramedic and not a nurse.

However, I take issue with you calling me a “Mobile L.V. N. (or L.P.N. in my neck-o’ the-woods). LVN/LPNs don’t go nearly as advanced as what we do, nor would it be appropriate for them to do so. I’ve worked with pretty much any licensure level out there and I’ve seen how we fit together. Paramedics are not physicians, and I won’t say that my education and training is even something to compare to theirs, however the thing that differentiates paramedics from nurses is ultimate responsibility. Nurses get orders given to them, Paramedics give orders. Sure, we have protocols and standard operating guidelines, but the person who chooses what to use is the paramedic. It is our assessment skills, our knowledge, and our capabilities to determine a working diagnosis and treatment plan in any circumstance that delineates our profession from the others. A paramedic is a clinician. We have a skill set that has been determined to be necessary in the field by a lot of anecdotal evidence and some measure of real research. That skill set doesn’t get to be pulled out as much as perhaps it should be, but when we need to use it, we need to. As a lone paramedic responding, my skill in performing critical interventions is the measure of life or death for a certain, small percentage of patients. Usually I function in a role to take some of the pressure off of overworked ER staff by thorough assessment (that they usually ignore) and by starting IV lines and pushing some comfort medications. However, in the small percentage of time where I have to pull something like, say electrical or chemical cardioversion, ET intubation, surgical airway placement, pleural decompression, or even a pericardiocentesis out of my bag of tricks, they have to be done right there and then or the patient will die right there and then. That’s why we have the skills, not so that they can be done as perfectly or as prettily as a surgeon would do them, but because the alternative to them being done is the death of the patient.

And that’s why I take exception to being called that. Show me an LPN/LVN with that responsibility and I’ll show you hundreds of examples where so called “skilled nursing” has killed and tortured patients. I know of some darn good LPNs that I’ve seen at nursing homes, I think that I’ve read about them in a book somewhere (ok, that was too mean) but for every one of them I know, I can tell you a story of, say the LPN that called me for a hypotensive and unresponsive patient whom she had been dutifully placing duragesic and NTG patches on per her orders… WITHOUT TAKING THE OLD ONES OFF.

But I digress, this has turned into an over 1000 word rant by now. Honestly, you seem to be a good man and a good nurse motivated by good intentions. All of us health bloggers are I think, or we wouldn’t be health blogging. I look forward to your comments and our discussions coloring my rantings and you should anticipate mine on your blog. I don’t disrespect nurses any more than nurses disrespect me.

So, tRNfkatAMN, welcome to my corner of the blogosphere, please stick around, kick off your shoes and take a well deserved breather. Then yell at me… I like it.