Health Care Providers at Risk

I'm good at what I do because I love it.

I have been associated with the health care field for much of my life. I was a volunteer and first responder at our local fire department, EMT, Certified Nurse's Aide then attended college toward a Bachelor's degree in the nursing program. I have great respect for those that dedicate their lives to the demanding health care profession. This is not an article about my love for the field of health care. It is quite the opposite.

The term Burn Out is used often in the health care profession. It is a leading cause of good nurses and EMT's leaving the field. It should not be assumed we are simply tired and bored with saving lives day in and day out. Burn Out in the health care field refers to the monotony of constantly struggling with the unrealistic demands of administrations, medical-legal jargon and risks to our license every day we put on our uniform. The joy I felt after saving someone's life was the reward that made it all worth it. A gentleman once came to our table while I was having dinner with friends and exclaimed, "This man saved my life. I just want to thank him." I could honestly say I loved my work.

As an EMT, I enjoyed my job but the business side of the profession I could live without. We were constantly under changing administration and always having to adjust to changing policies. Supplies were difficult to keep stocked and sometimes our patient care suffered for it. 

We even had to protect ourselves from our own management who would lay the burden of failing equipment and lack of needed supplies on our shoulders. I left the career I loved after our office finally closed. After a bitter and childish rivalry between our new EMS Service and the local established service, we were left jobless. Those of us who worked for the new service were prevented from ever working with the local service. After witnessing the behavior of the local EMS administrator, I lost all respect for the man and had no desire to work for him.

While attending college toward a nursing degree I was offered a position as a Nurse's Aide in the state operated mental facility for the elderly. Our orientation was basically various insurance agencies attempting to get us to sign up for their policies. I was sent to work in the elderly ward. Again, the job of caring for my patients was greatly rewarding. All seemed well until after our first scheduled health physical.

A week following our physical examination 14 of us had been relieved of our positions with no apparent cause. A former health care worker called me later to inform me that I needed to go to a doctor immediately. Each of us that had been relieved had been exposed to the tuberculosis virus. The facility had taken insured patients with active TB and neglected to warn the staff. I started a regimen of treatment for 6 months for my exposure. I was among the few lucky to have only been exposed. Other health care workers were not so lucky and developed active TB. We had no legal recourse due to the fine print in our employment contracts stating we relinquish our rights to sue a state facility. This cost me a semester of college considering I could not go near patients while under treatment for TB. My coworkers who were now sick would spend the rest of their lives under house quarantine.

When I finally was able to attend college again I completed 4 of 5 semesters toward a Bachelor's Degree in Nursing. During my last 4^th Semester clinical, a young mother lost her baby during childbirth. All the nursing students as well as the student instructor huddled around the pediatric nurse attending to the stillborn infant. The operating physician stated the mother was losing blood. None of the nurses seemed to hear him. I stepped forward and stated that I was a licensed EMT and I would help. We stabilized the mother. The student instructor and other attending nurses did finally help him finish.

The mother was one of my patients. I was with her when she awakened and I informed her that she had lost her child. I asked her husband to come in and I stepped out. My nursing instructor pulled me into the nurse's lounge and berated me for my lack of empathy for the child and the mother. She informed me that it was my place as her nurse to remain at her side while she dealt with the emotional pain of losing the child.

I began taking off my equipment and filled the instructor in on some things she had overlooked. She and the other students whimpered over the infant that was in the competent hands of a pediatrician and left the mother to bleed out. When the mother awoke, I took her vitals and administered her medication. The task of dealing with her loss was well covered by a strong and loving husband with whom I had spoken already.

I had worked in and around the health care field since I was 16 years old until I was 30. I was considered a veteran in the field when most people my age were barely out of high school. I still love the work and I keep my EMS license current each year. But I will never do it as a profession again.

Previously Posted on FullofKnowlege.com

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Health Care Providers Protect Your License!

When in doubt, always err on the side of life. That's what we do as health care providers. The unique aspect of being a health care provider whether you are a nurse, EMT or First Responder is that you never really leave the job. At any moment, no matter where you are, you could be called upon to save someone's life. But there is a myth that a gray area exists somewhere between delivering life saving care and violating health care policy. There is no gray area.

It's chilling to think that you could be held legally liable or even face criminal charges for doing your job as you were trained in an effort to save a patient's life. The reports of health care providers placed in this situation are frightening to the rest of us in the field. The best way to protect yourself and your license, as a health care provider, is to be aware of the laws governing your state and the policies of your place of employment.

DNR

Do Not Resuscitate orders have often been the focus of confusion in the health care field and is the classic gray area scenario. Again, there is no gray area here and the DNR aspect of patient care is there to clearly define your role as a provider in the event of the existence of a DNR order. If a DNR order exists you can not provide life saving measures to the patient. The patient, or those responsible for the patient, have expressed their wishes to not have life saving care should their heart stop or they stop breathing. DNR is a legally binding expression of the patient's and/or family's will.

The first thing you do as an EMS provider when you arrive on a scene is to ensure your scene is safe. Many elder care facilities may have policies in place regarding the care of their patients in cardiac arrest or have stopped breathing These policies may protect the employees of the facility but they do not protect you. The DNR order must be with the patient upon your arrival for you to be legally relieved of your responsibility to provide care. If the nurse informs you of a facility policy to deny care but cannot provide a DNR, your scene just became extremely dangerous. You must obtain documentation from the nurse that he/she refused to allow you to treat the patient. Annotate this in your own report and make your on duty medical control physician aware of the situation. Remember, their facility policy does not protect you as an arriving EMS provider.

Working For an Elder Care Facility or Home Health Agency

Nurses should be aware of a facility's policy on patient care before they accept employment. As mentioned earlier, different facilities have different policies regarding patient care but all these policies are written to protect the facility not the nurse. Being aware of your legal responsibility to your patient as outlined by your state is the best protection from liability. When a facility's policy deviate from those you are obligated by the state to follow you should not work there.

Good Samaritan Laws

Good Samaritan Laws are generally accepted provisions by the state that protects you as a health care provider in the event you happen upon a patient in need of life saving care. DNR and facility policy do not apply if the situation is spontaneous and occurs outside of a care facility. You are expected to perform life saving care as would be reasonably expected of any health care provider possessing the same skills and training. In the unlikely event this patient has a DNR with them in clear view of you at the scene of the incident then the DNR would apply.

The purpose of this discussion is to help remind us that there is no gray area. Those licensed and employed in the health care field must be aware of their state's laws regarding patient care as much as they are expected to remain current with their medical training. The same advice for protecting yourself from a potentially dangerous scene will protect you from the medical/legal dangers as well. Being prepared is the best protection

Sources/Resources

Previously Posted on FullofKnowlege.com

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Edenjaid worked in EMS for 6 years and studied in Health Sciences at University of West Alabama