# Should nurses be required to complete ride alongs with FD



## SFLfire (Mar 28, 2013)

So far I've done 3 ride alongs and just completed my hospital clinical.  Honestly, I thought I was going to be bored out of my mind but I was WRONG.  I had just as much, if not more fun, than I've had on my ride times.  I got a lot more practice in the hospital and gained more respect for nurses and how busy they really are.

As far as I know, nurses don't have to do ride times but do you think they should?  Would it help them with their education or be a waste of time?

Also, did you see more action on you're ride times or at the clinicals?


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## abckidsmom (Mar 28, 2013)

The trouble with people getting "a taste of how it is" clinicals is that inevitably it's a slow day. 

I wish it worked. 

I'm trying to convince our department's secretary to come ride with us one day. She is a great secretary but clueless about EMS so I'd love to see her be more effective in her job by understanding ours better.


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## DesertMedic66 (Mar 28, 2013)

A couple of our nurses at our trauma center were EMTs and medics. So they have the prehospital experience. 

The only nurses that are required to do ride outs are MICNs. I believe they only have to do 1 or 2 shifts during their training and that's it. 

We just got a new CE specialist who has been doing ride outs with our crews due to her never working in the county before.


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## ExpatMedic0 (Mar 28, 2013)

More like, should the FD be required to do ride alongs with a health care agency....


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## VFlutter (Mar 28, 2013)

For ER nurses it should be encouraged but not required. It would be nice for them to get a better understanding of what EMS does and the uniquie challenges they face in the field.

Help with education? No, but it may help improve communication and transfer of care.


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## Imacho (Mar 28, 2013)

I have seen nursing students and MD that are soon to start their residency in the ER do ride a longs with us. They all seem to have had an enjoyable experience during their ride time.


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## Carlos Danger (Mar 28, 2013)

Chase said:


> For ER nurses it should be encouraged but not required. It would be nice for them to get a better understanding of what EMS does and the uniquie challenges they face in the field.
> 
> Help with education? No, but it may help improve communication and transfer of care.



This.

ED nurses are the only ones who would benefit. 

But since ED nurses are <1% of all nurses, it would not be beneficial overall to make EMS ride alongs a mandatory part of basic nursing education. 

However, it would be a great thing for an ED to require as part of the orientation process for new ED nurses. 

I have been both a street medic and an ED RN, and I know firsthand that much of the friction that exists between paramedics and ED nurses is due to lack of understanding of what each other does and needs from the other.

Paramedics think RN's are overpaid and do nothing but sitting around sipping latte's and wouldn't have a single thought in there head if it weren't put there by a doctor, and RN's think that paramedics are clumsy dunderheads who don't know the first thing about real patient care. Both are wrong and can benefit from really looking at what the other one does.


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## EpiEMS (Mar 28, 2013)

Halothane said:


> This.
> 
> ED nurses are the only ones who would benefit.
> 
> ...



Perhaps the BCEN would do well to make EMS ride-alongs required for CEN designation? Or the ENA for TNCC?


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## Carlos Danger (Mar 28, 2013)

EpiEMS said:


> Perhaps the BCEN would do well to make EMS ride-alongs required for CEN designation? Or the ENA for TNCC?



Probably not a bad idea, but it'll never, ever happen.


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## EpiEMS (Mar 28, 2013)

Halothane said:


> Probably not a bad idea, but it'll never, ever happen.



Certainly wouldn't, I agree about that


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## VFlutter (Mar 28, 2013)

Halothane said:


> But since ED nurses are <1% of all nurses, it would not be beneficial overall to make EMS ride alongs a mandatory part of basic nursing education.



Judging soley on my experience as a floor nurse my view of EMS would be very cynical. Most nurses will only encounter IFT EMT/Medics regularly and in their point of view it is basically just a ride. 

Ya, I agree it will never be required for CEN/TNCC. Nursing care starts when that patient rolls through the door regardless if brought in by EMS or not. You have to expect that you will be starting from nothing. If some intervnetions were initated by EMS then great you are ahead of the game. Ride alongs would not really change that thought process.


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## DesertMedic66 (Mar 28, 2013)

Chase said:


> Judging soley on my experience as a floor nurse my view of EMS would be very cynical. Most nurses will only encounter IFT EMT/Medics regularly and in their point of view it is basically just a ride.
> 
> Ya, I agree it will never be required for CEN/TNCC. Nursing care starts when that patient rolls through the door regardless if brought in by EMS or not. You have to expect that you will be starting from nothing. If some intervnetions were initated by EMS then great you are ahead of the game. Ride alongs would not really change that thought process.



Lets be realistic here haha. Nursing care starts when you give a hand over to the nurse. Not always as soon as you roll through the door haha.


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## Imacho (Mar 28, 2013)

DesertEMT66 said:


> Lets be realistic here haha. Nursing care starts when you give a hand over to the nurse. Not always as soon as you roll through the door haha.



^^agree.


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## JPINFV (Mar 28, 2013)

DesertEMT66 said:


> Lets be realistic here haha. Nursing care starts when you give a hand over to the nurse. Not always as soon as you roll through the door haha.




No... it's when the patient gets transferred off the ambulance gurney. After all, we can't have the hospital taking care of patient sitting in the hallway. 

/glares at PIH in Whittier.


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## Medic Tim (Mar 28, 2013)

When I worked in the US for a hospital based service, the ER RNs had to go on at least 5 911 calls and 1 cct during their orientation. The CCRNs had to do so many EMS shifts a year.


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## Handsome Robb (Mar 28, 2013)

I think nurses should have to ride with EMS...not the fire department, their job has nothing to do with water and fire and kicking doors in!

Alright I'm done poking the anthill.


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## Handsome Robb (Mar 28, 2013)

schulz said:


> More like, should the FD be required to do ride alongs with a health care agency....



Agreed 100%

Our biggest problem here is all the shiny new fire guys are :censored::censored::censored::censored:ing clueless when it comes to patient care and it causes problems and disconnects in the continuity of care.


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## JPINFV (Mar 28, 2013)

So... remind me again why the circulating nurse needs to do a ride along? Should paramedic students be required to do X number of hours at a nursing home? How about on a med-surg floor? In the OR... and I don't mean pop in, do the intubation, and bail either. Like chill with the circulator, etc. 


On a serious note, I could put an argument that the paramedic students should assist with a full case, from pre-op assessment to extubation, not just pop the tube and leave.


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## reaper (Mar 28, 2013)

Here CCRNs are required 5 rides a year.

The med students are required to obtain thier EMT and then do 1 ride a month, for first two years of med school. This is only school in country that does it. The Med students love it and I think it will help with relations down the line.


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## JPINFV (Mar 28, 2013)

reaper said:


> Here CCRNs are required 5 rides a year.
> 
> The med students are required to obtain thier EMT and then do 1 ride a month, for first two years of med school. This is only school in country that does it. The Med students love it and I think it will help with relations down the line.




If I had to take an EMT course as a 1st year, I swear I'm going to be "that guy" and poke as many holes in the curriculum that I can. 

"You can't say that, you aren't a doctor!" 

"Um... not yet... and the entire point of me being in school is to be one... so why am I wrong?" 

I'll also go on record now by saying that clinical exposure during preclinical years is overrated simply because it's normally not tailored into an appropriate learning experience nor do the students have the necessary foundation to make any sort of decisions. I would bet money that the lasting impact of the experience, while enjoyable, would receive a low rank if the 4th years were given a survey about the quality of the experience. Enjoying something and making it meaningful are not the same thing.


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## SFLfire (May 1, 2013)

Wow, completely forgot I posted this.  If anyone is still reading this (doubt it) my reasoning was not so much for the nurses to learn anything, it was just to get them to know the difference and maybe have a different kind of appreciation.  Medics and EMTs have to do shifts in the ER and we're not really learning anything new in there.

As far as the FD comments are concerned, down here, 911 ambulance service is ran by FD so 90% of firefighters are also medics.


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## chaz90 (May 1, 2013)

SFLfire said:


> Medics and EMTs have to do shifts in the ER and we're not really learning anything new in there.



That just means you're doing it wrong. Depends on the staff at the ED to some extent, but I got a lot out of my ED clinicals and times shadowing ED docs.


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## SFLfire (May 2, 2013)

chaz90 said:


> That just means you're doing it wrong. Depends on the staff at the ED to some extent, but I got a lot out of my ED clinicals and times shadowing ED docs.



Not sure.  I only did one clinical.  Maybe when I get to medic school and do more of them, I'll learn something.


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## Milla3P (May 2, 2013)

SFLfire said:


> Not sure.  I only did one clinical.  Maybe when I get to medic school and do more of them, I'll learn something.



This is what's wrong with our prehospital healthcare system, folks.


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## Summit (May 2, 2013)

I think EMS ride-alongs are a great idea for ED nurse orientations and maybe for CHRNs.
I think CCT ride-alongs are a great idea for ICU nurse orientations.
For the other 95% of nurses, it is not time well spent (and there wouldn't be enough available EMS shifts as there are roughly 13+ RNs for every EMT/Medic in the US).


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## Carlos Danger (May 2, 2013)

Summit said:


> I think CCT ride-alongs are a great idea for ICU nurse orientations.
> For the other 95% of nurses, it is not time well spent



It would not be time well spent for most ICU nurses, either.


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## Summit (May 2, 2013)

Halothane said:


> It would not be time well spent for most ICU nurses, either.



shhhhhhhh it would be fun! -_-


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## SFLfire (May 2, 2013)

I see a lot of people saying its pointless for most nursing students to have ride times so let me ask this.  Isn't it pretty pointless for emt students to have clinicals?  Again, what are we learning?  Not a medic, can't do very much.

Maybe its because nothing that big happened during my time in the hospital.  Maybe its because half of our school instructors were retired nurses and went really in depth with their lectures.  Maybe we just didn't know the right questions to ask.

Experience in seeing how the other side works is all we got out of it.


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## Carlos Danger (May 2, 2013)

SFLfire said:


> I see a lot of people saying its pointless for most nursing students to have ride times so let me ask this.  Isn't it pretty pointless for emt students to have clinicals?  Again, what are we learning?  Not a medic, can't do very much.
> 
> Maybe its because nothing that big happened during my time in the hospital.  Maybe its because half of our school instructors were retired nurses and went really in depth with their lectures.  Maybe we just didn't know the right questions to ask.
> 
> *Experience in seeing how the other side works is all we got out of it.*



Even if that is all you got out of it, that's pretty valuable in itself.


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## AtlasFlyer (May 2, 2013)

I only spent 8 hours in clinicals at the ED as part of my EMT-B program this semester.

It was an incredible learning experience! Patient interaction, seeing the trauma room in use, and I probably only absorbed a fraction of what was going on around me. 

Pretty much everything in life is a learning experience, if we want to learn something from it.


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## SFLfire (May 2, 2013)

Halothane said:


> Even if that is all you got out of it, that's pretty valuable in itself.



This.  This is my point.  Experience.  It goes back to my original question.

Look, I loved my clinical, all of us did.  There were 6 of us at the hospital and at the end, as we were walking to our cars, we all said we wish we could do another one.  The steady flow of patients was great!

But if gaining nothing but experience was helpful for an emt student, why wouldn't it be helpful for a nursing student?  Why not get as much exposure as possible?  Its not time wasted when you consider some of them may end up in pre hospital or critical care nursing.


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## VFlutter (May 2, 2013)

SFLfire said:


> But if gaining nothing but experience was helpful for an emt student, why wouldn't it be helpful for a nursing student?  Why not get as much exposure as possible?  Its not time wasted when you consider some of them may end up in pre hospital or critical care nursing.



Because a very small percentage of nursing students will end up in the ER or in Critical Care. For the vast majority of nursing students it really would not add much to their learning experience. There are better ways to spend their time. You get a much better chance of seeing more patients and doing more procedures in the ER than you would on an ambulance.

In nursing school you have relatively few shadowing shifts. I would much rather be in the ICU, Cath lab, Surgery, Neuro, etc


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## hogwiley (May 2, 2013)

I doubt it would make much difference if ER nurses did ride alongs. Some of them were EMTs or Medics(or still are) and are already familiar with EMS, and its not like it makes much difference how they go about things in the ER. 

This reminds me of a patient I brought into the ER recently secured to a board with a KED on, and the Nurse thought the KED was the coolest thing shed ever seen and said she wanted to take an EMT course some day so she could play with our all neat toys(no im not making this up).


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## Carlos Danger (May 3, 2013)

SFLfire said:


> But if gaining nothing but experience was helpful for an emt student, why wouldn't it be helpful for a nursing student?  Why not get as much exposure as possible?  Its not time wasted when you consider some of them may end up in pre hospital or critical care nursing.



The reason hospital time is extremely valuable for EMT's and paramedics is because the hospital is where medicine is done. It's where you go to learn about patient care, whether you are training to be a paramedic, a nurse, or a physician. There is simply no where better go to see sick patients receive care.

On the other hand, not that much happens clinically on an ambulance that the nursing student or new nurse won't get exposure to in the hospital.

EMT and paramedic students could probably learn something from doing rotations in primary care settings, so why don't we send them there? Because, even though that might be of some benefit, we have a limited amount of time and money to spend on training, so we have to go where we get the most bang for our buck. 

For a paramedic, that place is not a family doctor's office. For a nurse, that place is not the ambulance.


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## Rialaigh (May 3, 2013)

How about requiring every nurse going through nursing school to do 3-4 shifts with a critical care interfacility transport team. Most of those teams in busy cities transport 3 or more patients a shift, most on drips..etc..etc...

I think that would be good experience and worth the time to take away from the floor. 


I absolutely agree that 9-1-1 is not a place a nurse needs to be to learn,


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## VFlutter (May 3, 2013)

Rialaigh said:


> How about requiring every nurse going through nursing school to do 3-4 shifts with a critical care interfacility transport team. Most of those teams in busy cities transport 3 or more patients a shift, most on drips..etc..etc...



I agree that it would be an awesome learning experience but not feasible for every nursing student. Also, as I mentioned before the vast majority of nurses will never be ICU nurses, manage vented patients, etc and most do not want anything to do with it.


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## Rialaigh (May 3, 2013)

Chase said:


> I agree that it would be an awesome learning experience but not feasible for every nursing student. Also, as I mentioned before the vast majority of nurses will never be ICU nurses, manage vented patients, etc and most do not want anything to do with it.



I know, I'm just thinking if we are going to require something, it would need to be along the lines of critical care transport so as to be sure that the student would see XYZ in the field over 3-4 days.


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## Summit (May 3, 2013)

The majority of nursing students only get 2 ICU shifts during school. I don't know of any that get CCT.


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## JPINFV (May 4, 2013)

Halothane said:


> The reason hospital time is extremely valuable for EMT's and paramedics is because the hospital is where medicine is done.


Than why was it that when I did my hospital time as an EMT I only interacted with a nurse, and that was barely? If I was supposed to be exposed to medicine, shouldn't training facilities be working with the physician group staffing the emergency department than the hospital itself?


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## ExpatMedic0 (May 4, 2013)

My Paramedic program required that I do 2 clinical rotations in med/surg with a floor nurse. The staff was great, and I found the estrogen driven gossip of the nurses station interesting. However, beyond that, I got to see the life of a floor nurse. It was interesting and a cool experience, but to be honest it did nothing for my clinical skills, nor did it help me as a Paramedic. It did not relate to my job at all. I am not sure how much the school paid for that time or wasted with it, but it could have been spent much better in the ICU or the OR for a Paramedic student. 
I guess this is somewhat what it would be like placing a nurse with the fire department, impractical and wasteful. Also since it is a fire department doing patient care here..... would it not make more since to make the fire department shadow a health care agency?


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## Carlos Danger (May 4, 2013)

JPINFV said:


> Than why was it that when I did my hospital time as an EMT I only interacted with a nurse, and that was barely? If I was supposed to be exposed to medicine, shouldn't training facilities be working with the physician group staffing the emergency department than the hospital itself?



I don't know, I wasn't there. The person to ask would probably be the person who told you to follow the nurses around.

My guess would be that they thought you'd get more practical patient exposure with the nurses than with the docs, or that the docs just didn't want to be bothered with an EMT student.


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## SFLfire (May 4, 2013)

ExpatMedic0 said:


> My Paramedic program required that I do 2 clinical rotations in med/surg with a floor nurse. The staff was great, and I found the estrogen driven gossip of the nurses station interesting. However, beyond that, I got to see the life of a floor nurse. It was interesting and a cool experience, but to be honest it did nothing for my clinical skills, nor did it help me as a Paramedic. It did not relate to my job at all. I am not sure how much the school paid for that time or wasted with it, but it could have been spent much better in the ICU or the OR for a Paramedic student.
> I guess this is somewhat what it would be like placing a nurse with the fire department, impractical and wasteful. Also since it is a fire department doing patient care here..... would it not make more since to make the fire department shadow a health care agency?



I think I made a mistake by JUST saying fire department and it might be throwing some people off.  I know that throughout a lot of the country, fire departments only hire Firefighter/EMTs...that's not the way it is where I live.  Down here FD also runs the emergency ambulance service so everyone has to be a Firefighter/Paramedic.  Private ambulance companies only do interfacility transports here.

Nurses would NOT be riding in the trucks or the engines, they'd be on the ambulance with medics.

Doubt that's going to change anyones mind, I just thought that I needed to point that out.


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## Clipper1 (May 4, 2013)

ExpatMedic0 said:


> My Paramedic program required that I do 2 clinical rotations in med/surg with a floor nurse. The staff was great, and I found the estrogen driven gossip of the nurses station interesting. However, beyond that, I got to see the life of a floor nurse. It was interesting and a cool experience, but to be honest it did nothing for my clinical skills, nor did it help me as a Paramedic. It did not relate to my job at all. I am not sure how much the school paid for that time or wasted with it, but it could have been spent much better in the ICU or the OR for a Paramedic student.



That is strange you feel that way since you started a discussion advocating Community Paramedics. 95% of what community medicine is about starts on the MedSurg floors. The assessments, education, retraining and case management to get a patient back home are all part of med surg. Sometimes the responsibility relies heavily on just the RNs and sometimes it is a collaboration of many different professionals. It is too bad you missed that. Being a Paramedic should be more than just getting to the neat skills especially when it comes to an overall assessment. Chances are the average EMS Paramedic will not be managing ICU ventilators, IABPs or multiple IV drips. Working a code in the ED and the stabilization which occurs there would be more practical.  


As far a nursing student riding on an ambulance, there is no point. Nursing education is done differently than the vocational tech style done by Paramedic programs.  A foundation is done and each step is in increments building up to a general nursing skill level. The education is there in the foundation but the experience and skills are developed as the nursing student advances and later picks a path to follow for the specific training. No one expects an RN to be ICU ready after even 4 years of college since there is just too much to learn to get to that point. This is why there are now extensive internships averaging 3 - 6 months for BSN RN grads to complete in a specialty as a bridge to employment.  The Paramedic program teaches the necessary skills to be job ready for a very specialized and also a very small percentage of medical care patients.


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## Summit (May 4, 2013)

JPINFV: Around here the EMT and medic students are almost always paired with RNs in the ED, and it is very appropriate.



ExpatMedic0 said:


> My Paramedic program required that I do 2 clinical rotations in med/surg with a floor nurse... It was interesting and a cool experience... I guess this is somewhat what it would be like placing a nurse with the fire department



I agree with this analogy 100% for the current vo-tech paramedic model.

However, I agree with Clipper1's response if one is arguing for an educated community paramedic model.



> I am not sure how much the school paid for that time


It would be very odd if this number was something other than zero. Nursing schools do not pay for clinical placements, nor preceptors. They only pay for clinical scholars who are employed by the school (though often dual-appointments with the (usually one scholar for 4-8 students).


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## Clipper1 (May 4, 2013)

However, for Med Surg a Paramedic can:

Start IVs

Check for IV complications (some might even be from field sticks)

Learn about the different insulins and see how RNs manage glucose protocols

Have at least 50 patients to listen to breath and heart sounds

Do vitals. This also is a weak area for some as it appears in the discussions here. 

Do NG tubes (I think some Paramedics are able to do these although I have not seen it)

Learn about aspiration.

See the many different medications given to one patient daily in various forms depending on swallowing ability and how many one RN must give in one shift.

See the many different access ports which are used routinely which was a recent discussion and it seems many do not get the experience even if they are allowed to access them. 

Learn about infection control and the various infectious diseases which seems to be a very weak point as we have seen from routine transfers and some  EMS providers who continue to wear their contaminated gloves everywhere in the hospital after they drop off a patient.

Learn about spinal injury patients and how to move them carefully pre and post op. This might benefit those who don't believe any precautions are necessary. A LSB might not always be required but we also don't just walk them or toss them around either. Talking to a patient who is a fresh quad and see how they may not have exhibited any symptoms initially might be an eye opener also.

Caring, including suctioning, for a tracheotomy or stoma patient. Learning how to remove or secure a prosthetic speaking valve on a laryngectomy patient is helpful if you need to secure an airway. 

Nasotracheal suctioning

Learning the various oxygen delivery devices including those which are considered High Flow. (NRB masks are not)

Learn the various neuro assessments for acute and ongoing for various disease processes both known and unknown. 

Rapid response teams in action...nurses working without a doctor present and by their protocols.

Check out the extensive protocol sets of a med surg nurse.

Have a chance to read 50 histories, look up labs and check out X-Rays which are all usually available on a computer.  Of course your preceptor will need to have a student access code.

Read the 12 lead ECG interpretations and the cath lab reports. View the actual cath lab diagnostics on the computer.

Learn about the various pacemakers.

Learn more about DVTs and how they could present which is not always textbook.

Have a chance to see what other health care professionals do. Even RNs do more than just gossip at the nurses station. FFs and Paramedics have their own gossip which is often hear in the ER often heard over the patient during a drop off. 

Learn about pain management both acute and chronic. 

Watch bedside procedures such as a thoracentesis, PICC insertion and sometimes central line insertions. You can take notes on the steps to insure a clean or sterile setting. 

If your class instructor structures a clinical rotation correctly there is an unlimited amount of things to see with over 50 patients to have access to.  The problem is many instructors fail to structure with an outline of what is expected. Instead they just send a student to the ER or floors to "follow someone" who  is usually the person who does not like students because they are not getting paid extra and have a heavy assignment.  If the charge RN sees your outline, he or she can see that you get those things done and you may not be stuck with just one person as a tag along.


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## JPINFV (May 4, 2013)

Clipper1 said:


> However, for Med Surg a Paramedic can:
> 
> Start IVs
> 
> ...




All of which can be done in more appropriate settings (in terms of the likelihood of the device being present, intervention being performed, and patient turnover) like the ED, PACU, or ICU settings than a general med-surg floor. This is, of course, assuming that the licensed nursing staff knows what they're talking about. I've seen rapid response calls put out because the nursing staff couldn't figure out how to trouble shoot a pulse ox and discussions about whether femoral lines are PICCs or not because they aren't on the chest. Similarly, I wonder how many RNs think that a tunneled IJ line is a subclavian due to the location the line exits the body.


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## Clipper1 (May 4, 2013)

JPINFV said:


> All of which can be done in more appropriate settings (in terms of the likelihood of the device being present, intervention being performed, and patient turnover) like the ED, PACU, or ICU settings than a general med-surg floor. This is, of course, assuming that the licensed nursing staff knows what they're talking about. I've seen rapid response calls put out because the nursing staff couldn't figure out how to trouble shoot a pulse ox and discussions about whether femoral lines are PICCs or not because they aren't on the chest. Similarly, I wonder how many RNs think that a tunneled IJ line is a subclavian due to the location the line exits the body.



You also complained about being with a nurse in the ED.  

Not all nurses are as stupid as you make them out to be in your post.  I could also list many incidents where EMTs and Paramedics have screwed up on the pulse oximeter. Just read some of the discussions on this forum and you will see those in EMS are not perfect either.  

This constant bashing of other health care professionals is what keeps some EMT and Paramedic students out of many clinical situations. No one wants you in their area if you already have formed an opinion based on some anonymous internet forum that you are better than anyone else and haven't even got a good start in your Paramedic program.  

Some of the responsibility should also fall on the instructors of the Paramedic programs also.  

What exactly is a Paramedic going to learn in PACU?  It is very rare they have a code and Paramedics need to know how to keep an ETT in and how to  not pull them out.  

The patients on med surg would more likely be the type of patients an EMT or Paramedic would most likely see. Not everyone is a trauma and not everyone is just a band aid in the ER. These are the patients who need to be transported and will get admitted for medical illnesses either acute or chronic exacerbations. 

Why should a beginning Paramedic student jump right into an ICU and see equipment that most have never even read about and will probably never see in the field? Why not learn patient assessment over and over again? Med Surg floors in major hospitals have hundreds of patients. It seems some just want to dive right into the neat skills part and miss a lot of stuff at the beginning and inbetween. 

Also on med surg you can learn to talk to the patients. Of course you might also have to talk to the nurses which might be difficult for some like yourself.


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## JPINFV (May 4, 2013)

Clipper1 said:


> You also complained about being with a nurse in the ED.


And if we're talking about a limit time to learn how to make clinical judgement, than I stand by my argument that physicians are a better match. 


> Not all nurses are as stupid as you make them out to be in your post.  I could also list many incidents where EMTs and Paramedics have screwed up on the pulse oximeter. Just read some of the discussions on this forum and you will see those in EMS are not perfect either.


...and not all EMTs and paramedics are stupid either. However I see a lot more documentation issues when I look through nursing documentation than EMS documentation. 


> This constant bashing of other health care professionals is what keeps some EMT and Paramedic students out of many clinical situations. No one wants you in their area if you already have formed an opinion based on some anonymous internet forum that you are better than anyone else and haven't even got a good start in your Paramedic program.


1. I'm not in a paramedic program. 
2. If you want some interprofessional bashing, have you tried looking in the mirror?
3. My chain of command doesn't involve nurses anyways. 



> Some of the responsibility should also fall on the instructors of the Paramedic programs also.


Completely agree. 



> What exactly is a Paramedic going to learn in PACU?  It is very rare they have a code and Paramedics need to know how to keep an ETT in and how to  not pull them out.


You were the one who mentioned oxygen administration devices, not me, and I've seen more variety on ways to deliver oxygrn there than on the floors where often my team wouldnt have any patients on supplemental oxygen. Also,  unless the patient was going to the ICU, they were extubated in the OR anyways. 

The patients on med surg would more likely be the type of patients an EMT or Paramedic would most likely see. Not everyone is a trauma and not everyone is just a band aid in the ER. These are the patients who need to be transported and will get admitted for medical illnesses either acute or chronic exacerbations. 


> Why should a beginning Paramedic student jump right into an ICU and see equipment that most have never even read about and will probably never see in the field? Why not learn patient assessment over and over again? Med Surg floors in major hospitals have hundreds of patients. It seems some just want to dive right into the neat skills part and miss a lot of stuff at the beginning and inbetween.


because it makes more sense than med surge due to the acuity of the patients. However, for assessment and management, the ED is the best place for them. 



> Also on med surg you can learn to talk to the patients. Of course you might also have to talk to the nurses which might be difficult for some like yourself.


I always love your personal attacks. It warms my heart and tells me that I'm right. 

Of course taking to patients can also be achieved in the ED.


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## Clipper1 (May 4, 2013)

JPINFV said:


> And if we're talking about a limit time to learn how to make clinical judgement, than I stand by my argument that physicians are a better match.
> 
> ...and not all EMTs and paramedics are stupid either. However I see a lot more documentation issues when I look through nursing documentation than EMS documentation.
> 
> ...



A disgruntled med student.   What does it matter for this discussion  who your chain of command is as a med student? Did the mean nurses pick on you again?

I will only comment on a couple of things out of all that stuff you wrote since you want to resort to insults on nurses again.

You might read more documentation from nurses because they do a heck of a lot of documentation per patient. There are also a heck of a lot of nurses. Some of the larger hospital will employee over 1000 - 2000 RNs easily.  We have over 200 in just our Neonatal units.  Since you have not been a Paramedic, you may only have read a few of the Paramedic charts which happen to be on the patients admitted.   The important thing is "what did you do about the errors you found"? Do you know the regulations for the state and facilities you are in for reporting errors? Do you report only the errors of the nurses and not the Paramedics? 

I will also agree that there probably should be more physicians on the ambulances in the US like some of the European models.

I guess by your reasoning, Paramedic students really should not doing much interaction at all in the hospital since they will have to encounter nurses at some time.  Nurses also should not ride on with the fire department either if it is only to be for a superiority pissing match.

Maybe we should have more physicians on the ambulances in the US. Why is it that when of the advantages of certain clinical situations like in med surg are pointed out EMTs and Paramedics feel insulted?   Maybe an EMT or Paramedic student might get some ideas about what to ask for in clinicals or do something to take the initiative rather than just stand around waiting for someone to tell them to do something or for something cool to come into the ED.  I bet a lot of Paramedic students never knew what all they could see and maybe do in the hospital. 

Why is it EMS wants a nurse to ride on a fire truck or ambulance but is not willing to experience more patient care volume per time spent in a hospital situation? Some Paramedic students are barely seeing 3 or 4 patients in each clinicals and will limited assessments or skills.  The RN on the ambulance or fire truck probably will see the same and most patients will not need ALS skills.


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## Achilles (May 4, 2013)

Clipper, I notice you don't have your education listing below your name, do you mind telling th class what your education level is? Please.


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## SFLfire (May 4, 2013)

Clipper1 said:


> This constant bashing of other health care professionals is what keeps some EMT and Paramedic students out of many clinical situations. No one wants you in their area if you already have formed an opinion based on some anonymous internet forum that you are better than anyone else and haven't even got a good start in your Paramedic program.



Based on what I've seen (from internet forums) nurses bash medics just as much as medics bash nurses.  Go check out allnurses.com.  You know it happens both ways.


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## Akulahawk (May 4, 2013)

Clipper1, JPINFV is a 3rd year medical student, probably under a bit of stress, but I wouldn't describe him as disgruntled. In his case, he is going to be a DO. Because of his education, he will not need to attend Paramedic School after he's completed his formal education. If he wishes to add a Paramedic License, there's a challenge process through which he could do precisely that. 

I've read most of the thread. Something that popped up in my own mind after reading the last page or two is that I'm starting to think that it would be a good idea for a paramedic student to spend about a week in a hospital, doing (basically) just vitals and assessments, moving progressively from a very "basic" M/S unit for a few days to a tele unit for a couple days, to an ICU step-down unit for a couple days, and some may be offered the option of an observational shift in ICU. Then at the conclusion of that time, the paramedic student then rolls into the ED for their regular 160 hour clinical experience, as is currently structured, followed by their regular field internships.

The idea is not so much to get the student to talk to patients, rather it's to get experience doing physical exams on progressively more complex patients without the "drive" for them to do skills. Since each patient gets their own writeup, it gives the student a chance to really begin to see how problems can interact with each other. Then when they "arrive" at the ED for their rotation, they won't have to learn assessment on top of trying to get their required skills in. Instead, they'll simply be adding that stuff to their assessments. They begin learning how to manage patient care too. Later, when they get to their field time, they'll simply need polishing off for specific paramedic education. 

The end result (hopefully) is that paramedics educated this way will have a higher level of ability and knowledge as entry-level paramedics than they'd have been had they gone through a more "traditional" program... and it only adds a week or so to the entire length of the program.


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## Summit (May 5, 2013)

Akula makes some great points. The big barrier is you'd have to justify the paramedic student's learning experience being important enough to bump nursing students from those m/s floors and stepdowns because in many areas there are barely enough (or quite simply not enough) acute care clinical placements for nursing students. This shortage is why competitive programs get better clinical placements.


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## Akulahawk (May 5, 2013)

Summit said:


> Akula makes some great points. The big barrier is you'd have to justify the paramedic student's learning experience being important enough to bump nursing students from those m/s floors and stepdowns because in many areas there are barely enough (or quite simply not enough) acute care clinical placements for nursing students. This shortage is why competitive programs get better clinical placements.


Thanks! I think...  

Anyway, the way you bypass that problem is that you schedule those paramedic clinical times to coincide with an inter-session break that the RN/LVN programs have. What that results in is some medic students being loosed on the floors for about a week in between semesters. There won't be any nursing students on those floors and it's quite literally only (at most) 3-4 days per floor and they'll all be gone, with quite a few weeks remaining before the nursing students return. This does mean more care must be taken by the paramedic school's part to ensure that the group is ready for the in-hospital rotations on time. 

The big problem I see on the clinical side is ensuring that there are enough instructors available to supervise the students and ensure that they keep a tight lid on behavior. The other problem is ensuring that the students know their authorized scope of practice (effectively NONE), limited to vital signs and assessments as that's exactly what they're there to do and to whom to report to, when, and why! 

This actually also sparks an idea... have them also give report on their findings to the patient's nurse or clinical instructor. This way they get nearly immediate feedback about their assessments. I can also see a minor issue with authorizing charting in the EMR systems they'd have to add a category of student that's in a non-nursing category but has the ability to enter vitals and assessments.


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## Ecgg (May 5, 2013)

Clipper1 said:


> That is strange you feel that way since you started a discussion advocating Community Paramedics. 95% of what community medicine is about starts on the MedSurg floors. The assessments, education, retraining and case management to get a patient back home are all part of med surg. Sometimes the responsibility relies heavily on just the RNs and sometimes it is a collaboration of many different professionals. It is too bad you missed that. Being a Paramedic should be more than just getting to the neat skills especially when it comes to an overall assessment. Chances are the average EMS Paramedic will not be managing ICU ventilators, IABPs or multiple IV drips. Working a code in the ED and the stabilization which occurs there would be more practical.
> 
> 
> As far a nursing student riding on an ambulance, there is no point. Nursing education is done differently than the vocational tech style done by Paramedic programs.  A foundation is done and each step is in increments building up to a general nursing skill level. The education is there in the foundation but the experience and skills are developed as the nursing student advances and later picks a path to follow for the specific training. No one expects an RN to be ICU ready after even 4 years of college since there is just too much to learn to get to that point. This is why there are now extensive internships averaging 3 - 6 months for BSN RN grads to complete in a specialty as a bridge to employment.  The Paramedic program teaches the necessary skills to be job ready for a very specialized and also a very small percentage of medical care patients.



Clipper1 I must say every post you make is trying to showcase how much education and superiority you think you hold in this forum full of sheep. If you are such an astute ICU scholar why not produce a strong conducive argument to support your stance with facts without resorting to attacks? This only makes you look foolish and anything substantial you had to say is nullified by such statement:

"Chances are the average EMS Paramedic will not be managing ICU ventilators, IABPs or multiple IV drips." I have some news for you, as long as there are community hospitals, small rural hospitals, clinics and the MD deems so appropriate (see *MD*.... *m*akes *d*ecisions) that the patient needs to be transported and (*RN*.... *r*ecords *n*otes for discharge)  to a regional center via ground or air there will be EMT's and Paramedics doing said job. I know this may cause you a great deal of pain to read that, but it's the reality. 

I not going to lie, I never held nurses as someone I go check in with for differentials or diagnosis. Nor did I care for what were nursing interventions , because to me this was not medicine. You alluded in another post "If you want to be the best in ICU care you should become a nurse" no if you want to be the best in ICU care you would become a physician do 3 years IM residency and a fellowship in Pul/CC and be called an Intensivist that is what the best is.


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## Summit (May 5, 2013)

Ecgg: I hope you are only letting Clipper1's abrasive attitude drive your silly response. If so, rise above your emotions. I hope that you are not really that misinformed about the capabilities and regular practices of ICU nurses. If you think RNs are for "recording notes" and don't know anything about diagnosis, you need some perspective. Sure, RNs do not "diagnose"... just like paramedics don't "diagnose."


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## ExpatMedic0 (May 5, 2013)

Clipper1 said:


> However, for Med Surg a Paramedic can:
> 
> Start IVs
> 
> ...



haha wow, what med/surg is this? The BSN nursing staff that I was attached to where not allowed to start IV's, they called an "IV team" for that. They did not do any NG tubes while I was there, and to be honest it would be surprising if anyone could do such a thing on this floor.
I did follow one of the CNA's around when the RN was to busy. Helped out with cleaning up and vitial signs (all of which where done with automatic machines) I checked IV's that where setup, ect ect.

  In my 2 days time following them I mostly saw how they charted, worked the pixus, and handed mrs/mr smith their pills to take with a cup of water.

This was over 7 years ago and to be honest it has not been very helpful in my career or education as a Paramedic, or furthering my higher education. I did my best to my manage my time there and it was interesting to say the least, but Paramedic programs are not very long. We do not even get enough hours in the OR or the the ICU, or even the ED. Its not practical to place a paramedic student on a med/surg floor, just like its not practical to place an RN with a transporting fire department for all the same reasons.


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## ExpatMedic0 (May 5, 2013)

Clipper1 said:


> As far a nursing student riding on an ambulance, there is no point.


_double standard: noun
: a set of principles that applies differently and usually more rigorously to one group of people or circumstances than to another_
Also see Definition of HYPOCRITE


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## ExpatMedic0 (May 5, 2013)

Summit said:


> JPINFV: Around here the EMT and medic students are almost always paired with RNs in the ED, and it is very appropriate.
> 
> 
> 
> ...


Using the concept of community Paramedicine to support facts which have to do with clinical rotations of entry level paramedic students is a little out of context.   
Entry level Paramedic students are not even getting nearly enough clinical rotations in critical areas like the OR.



JPINFV said:


> All of which can be done in more appropriate settings


 Yes, that is an easy way of saying it. I agree. (Regarding the post above)


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## ExpatMedic0 (May 5, 2013)

Achilles said:


> Clipper, I notice you don't have your education listing below your name, do you mind telling th class what your education level is? Please.



If I was a betting man, I would put it all on RN. Espially if you read other post from that same person.

 or "VentMedic" the RT lol, if anyone has posted on this forum long enough to remember that uplifting character.


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## Summit (May 5, 2013)

ExpatMedic0 said:


> haha wow, what med/surg is this? The BSN nursing staff that I was attached to where not allowed to start IV's, they called an "IV team" for that. They did not do any NG tubes while I was there, and to be honest it would be surprising if anyone could do such a thing on this floor.



Again, I'm on your side from the "not the best use of limited time" point of view. However, I'll tell you that your m/s experience is very atypical. RNs not allowed to start IVs? What cockamamy crap is that? 

I'll contrast it to my first m/s rotation was on what was considered the lowest acuity inpatient floor in the hospital, which itself was not particularly acute: non-trauma center literally across the street from a level IV and down the road from a level I with its only standouts being a top notch OB/NICU and arthroplasty/surg. Nevertheless, I started NGs, IVs, and took patients down to interventional radiology and watched 2 procedures, etc. 

You have provided a good example on how skewed of a view one can get in just two shifts. I'll compare it back to EMT clinicals. We had 2 hospital shifts and one ambulance. The ambulance shift: zero calls. The "hospital," a rural level IV "ER" attached to an outpatient surgery center, 2 patients all day so they sent me to watch an Achilles tendon repair. While waiting for my one shift in an urban Level I, I was concerned about my non-experiences and begged for more clinicals, not permitted, but they relented and gave me two or three shifts in a Level 5 standalone "ER" that was more of an urgent care... at least I had about 15 pt contacts. Then I drove off for my shift at the Urban Level 1 ED and saw more patients than my other 5 clinical shifts combined and as much acuity in one shift as I did in my first year on a 911 ambulance. Actually, that sounds like a good argument for m/s rotations for EMT students instead of low volume rural services/clinics. Obviously Level 1 trauma center placements are the best, but harder to get.


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## ExpatMedic0 (May 5, 2013)

Summit said:


> Again, I'm on your side from the "not the best use of limited time" point of view. However, I'll tell you that your m/s experience is very atypical. RNs not allowed to start IVs? What cockamamy crap is that?



SW Washington medical center, Vancouver, WA, med/surg policy when I was there 2005, I shucks you not! ;-) I was also very surprised.

Regarding the rest of your statement, maybe it was just a bad luck shift, the same an EMT student could have on a ride along. I feel I learned a lot from Nurses and Doctors in the ED and the ICU... even OBGYN, I just can not say the same regarding my med/surg rotation and in retrospect it seemed to be a misuse of the students time and resources, which are extremely limited and focused.


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## Carlos Danger (May 5, 2013)

Summit said:


> RNs not allowed to start IVs? What cockamamy crap is that?



It's actually not all that uncommon in large hospitals.

I've been a couple places where the only nurses in the hospital allowed to start IV's were ED, ICU, and IV team staff.


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## ExpatMedic0 (May 5, 2013)

However, before we roam to far off topic.... I mentioned this because I thought it was a relevant comparison to the nurse riding with a transporting FD.


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## Summit (May 5, 2013)

^Ah, not in CO... the state where everyone gets to do IVs. EMTs, LPNs, and Medical Assistants can take a 32 hour class with an 8 hour clinical and get their State IV Approval certificate.

We have a daytime PICC/IV team staffed by ICU nurses who are called in for hard sticks with repeated failed starts. At night, they just call the ICU. Sometimes, a RN will be lazy and call without trying... drama ensues.


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## Carlos Danger (May 5, 2013)

Ecgg said:


> Clipper1 I must say every post you make is trying to showcase how much education and superiority you think you hold in this forum full of sheep. If you are such an astute ICU scholar why not produce a strong conducive argument to support your stance with facts without resorting to attacks? This only makes you look foolish and anything substantial you had to say is nullified by such statement:
> 
> "Chances are the average EMS Paramedic will not be managing ICU ventilators, IABPs or multiple IV drips." I have some news for you, as long as there are community hospitals, small rural hospitals, clinics and the MD deems so appropriate (see *MD*.... *m*akes *d*ecisions) that the patient needs to be transported and (*RN*.... *r*ecords *n*otes for discharge)  to a regional center via ground or air there will be EMT's and Paramedics doing said job. I know this may cause you a great deal of pain to read that, but it's the reality.



FWIW, Clipper1 was not wrong here. The _average_ paramedic does not manage ICU vents, IABP's, or multiple drips. They aren't even taught those things in school.

Even among those who do flight or CCT, most will never transport an IABP, and true ICU ventilators are almost never used in transport (an LTV1200 is not an ICU ventilator).

True, a few paramedics do these things - but definitely not the average paramedic.

Not really trying to make a point, I'm just sayin'.....


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## VFlutter (May 5, 2013)

Ecgg said:


> I not going to lie, I never held nurses as someone I go check in with for differentials or diagnosis. Nor did I care for what were nursing interventions , because to me this was not medicine. You alluded in another post "If you want to be the best in ICU care you should become a nurse" no if you want to be the best in ICU care you would become a physician do 3 years IM residency and a fellowship in Pul/CC and be called an Intensivist that is what the best is.



And how much time have you spent in an ICU? Or even a hospital for that matter. 

Many people do not realize how much input nursing has on medical care. It is a collaborative effort not just a Doctor giving an order and the nurses blindly following it. Many times a Doctor will give me options and ask me what I think would work best in the situation, other times I will ask for orders that they have not thought but think is a great idea. If my patient is in A fib RVR I don't run up to the doctor cluelessly but rather ask for a specific drip or bolus and they either agree or recommend something different. If someone can't maintain their pressure on a diltizem drip I will ask if we can switch to amino. I don't sit there and wait for the doctor to tell me. 

And during any given time I can guarantee the nurse knows more about the patients status, test results, etc then the multiple consults or sometimes even the attending. 

I am not claiming an ICU nurse is more of an expert than a Doctor or that a Doctor is not the final decision maker but to view the nurse as not worthy of consulting because they do not "practice medicine" is a bit ignorant. 

Ask a pulm/cc about their residency and you may be suprised how much they learned from nurses during that time. In a teaching hospitals ICU the nurses and residents usually have great interactions. 

As for nursing intervnetions. I will agree some may look dumb but many make a huge impact on the patients outcomes, discharge, and possible readmit. Doctors don't write orders to turn patients or skin wound care. If nursing did not do "nursing interventions" many of our patients would be septic from decubitus ulcers.


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## JPINFV (May 5, 2013)

Clipper1 said:


> A disgruntled med student.   What does it matter for this discussion  who your chain of command is as a med student? Did the mean nurses pick on you again?



I generally get along fine with the nursing staff. However, that comes from simply expecting them to do their job (nursing) and not my teams job (medicine). This includes me doing my job. If I'm writing my progress notes at 6am and notice that the 4 am vital signs includes something like an SpO2 of 88%, that means that I grab a vital signs machine and get a new number for my own documentation. Of course it also makes me wonder why they heck no one was called, since "MD notified, no new orders" is more common than radiologists adding "clinical correlation required" (I guess I hate radiologists now too, right?). For all of the "nursing should be done by nurses" propaganda, it's amazing how much medicine the average nurse wants to practice. 

Are  you just mad that I don't bow down to the altar of Florance Nightingale? 



> I will only comment on a couple of things out of all that stuff you wrote since you want to resort to insults on nurses again.


What insults? Seriously, point them out? When did pointing out that nurses not being 100% perfect angelic beings means that it's an insult? If that's the definition of "insult" than can you stop being a hypocrite and insulting paramedics? 



> You might read more documentation from nurses because they do a heck of a lot of documentation per patient. There are also a heck of a lot of nurses. Some of the larger hospital will employee over 1000 - 2000 RNs easily.  We have over 200 in just our Neonatal units.  Since you have not been a Paramedic, you may only have read a few of the Paramedic charts which happen to be on the patients admitted.   The important thing is "what did you do about the errors you found"? Do you know the regulations for the state and facilities you are in for reporting errors? Do you report only the errors of the nurses and not the Paramedics?


Did I say that I reported errors? Should I start reporting errors when there's something obviously wrong, like physical exam findings that haven't been present in 2-3 days, but keeps being put in the shift assessment documentation? Should I report every time something is off? As I'm concerned, the best course of action is generally to just recheck it myself, but I guess I can start getting the nursing board involved. Do you call the EMS authority/board every time you notice bad paramedic documentation? 




> I guess by your reasoning, Paramedic students really should not doing much interaction at all in the hospital since they will have to encounter nurses at some time.  Nurses also should not ride on with the fire department either if it is only to be for a superiority pissing match.



...because, somehow, the basic med-surg unit is the only unit in the hospital? Also, where have I advocated nurses ridding along with the fire department? 

You know what I wouldn't be fully adverse doing, though? I'll pull a couple 8 hour shifts with the nursing team, the nurses can pull a couple 30 hour shifts with the IM on call admitting team or surgical call team. 



> Maybe we should have more physicians on the ambulances in the US. Why is it that when of the advantages of certain clinical situations like in med surg are pointed out EMTs and Paramedics feel insulted?


Pointing out that there's more appropriate places isn't an insult. It's simply pointing out that there's more appropriate places for them to be. Why is your ego so fragile?



> Maybe an EMT or Paramedic student might get some ideas about what to ask for in clinicals or do something to take the initiative rather than just stand around waiting for someone to tell them to do something or for something cool to come into the ED.  I bet a lot of Paramedic students never knew what all they could see and maybe do in the hospital.



...because hospitals as a whole are large intimidating places where unless you understand intimately how it works, you end up walking on egg shells. Unless the paramedic is going to spend at least week working in the hospital full time, than it's fully understandable.


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## JPINFV (May 5, 2013)

Chase said:


> I am not claiming an ICU nurse is more of an expert than a Doctor or that a Doctor is not the final decision maker but to view the nurse as not worthy of consulting because they do not "practice medicine" is a bit ignorant.




I think it depends on the expectations on both sides. I won't argue that nurses spend a vast majority more time with individual patients than physicians (for a variety of reasons, including the fact that the physician can have 3-4 times the patients as the nurse). I think the problem comes when the nursing staff starts either demanding something inappropriate medically (i.e. sedating patients with delirium. Sure, it's easier for the nursing staff, but it's still bad medicine), is inappropriate for the time of day (unless it's an emergency or urgent situation, the overnight coverage team shouldn't be handling it), or simply ignores the medical orders for what ever reason and doesn't even bother notifying the primary medical team.


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## Ecgg (May 5, 2013)

Halothane said:


> FWIW, Clipper1 was not wrong here. The _average_ paramedic does not manage ICU vents, IABP's, or multiple drips. They aren't even taught those things in school.
> 
> Even among those who do flight or CCT, most will never transport an IABP, and true ICU ventilators are almost never used in transport (an LTV1200 is not an ICU ventilator).
> 
> ...



The difference here is what "manage" actually entails. In CCT environment we work darn hard in the sending facility to make sure the patient and crew have an unadventurous trip. 

If however patient condition deteriorates we don't have the luxury of recruiting higher trained members to gives us hands on assistance. In reality RN facade of management is calling the doctor or paging code "insert color of what your facility uses" and waiting for their response. 

If the patient goes in to cardiac arrest on your floor is RN allowed to initiate CPR? By that I mean prompt initiation of chest compression on your own accord? Because that is what this patient currently needs. Or you call the doctor? Or page/broadcast/announce/call response team?

If the IABP malfunctions, there is a timing error or patient sustains an arrhythmia is RN adjusting the IABP control and controlling the arrhythmia or the correct answer is one again call the doctor?

Any nursing exam if there is a choice “call the doctor” it’s usually the correct answer. 

Medics are not taught those things in school you are 100% correct. In addition if you don’t work for a hospital with today’s rules and laws you can’t even gain entry to ICU (to which you bring patients to constantly) for clinical time.  Even though the Intensivist allowed you to come, but the charge admin RN’s think it’s highly inappropriate for a Medic to do an ICU rotation with the MD.

Spending thousands of dollars out of my own pocket (because medics are rich) to take critical care, NRP, Stable, AHA, Airway Management classes etc. in hospitals to improve my patient care vs RNs who’s employer paid them to attend and they complain how early they had to wake up.  Getting dirty stares from all the nurses when I am the only medic in the room after we do the introductions, with witty comments to ensue like we didn’t know ambulance drivers needed this. 

This topic is of seldom use because in reality everyone has their own prejudices either through life experience, on the job experience, plain ignorance, lack of education and various combinations of their off.  I don’t expect RN’s to change their minds about ambulance drivers even though there are outliers and I don’t expect Paramedics to change their minds about nurses even though there are outliers. Will see if my outlook will change when I am in the medical student role, although honestly I think it will be worse.


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## Summit (May 5, 2013)

Clipper1 would do well to realize that his/her good points would be appreciated if some more tact was used. Bludgeoning your opponent will not convince them and at some point turns off the audience to what you have to say. I do my best to take the good info from Clippers posts while annoying the vitriol. I too would like to know Clippers credentials.



JPINFV said:


> Should I start reporting errors when there's something obviously wrong, like physical exam findings that haven't been present in 2-3 days, but keeps being put in the shift assessment documentation?


IMO it would be quite appropriate to report that to their manager. 
I've seen it and mentioned it within nursing... although I don't do it when I see physicians copying each others notes. It is funny because I recently read an article on this in the Journal of Critical Care Medicine:
Prevalence of Copied Information by Attendings and Residents in Critical Care Progress Notes
"Measurements and Main Results: EIghty-two percent of all residents and 74% of all attending notes contained greater than or equal to 20% copied information (p = 0.001)."



> You know what I wouldn't be fully adverse doing, though? I'll pull a couple 8 hour shifts with the nursing team, the nurses can pull a couple 30 hour shifts with the IM on call admitting team or surgical call team.


Frankly, I think that would be awesome. Where do I sign up? I think I'd learn a ton; I know I do when I use my lunch break to attend grand rounds. (FYI most acute care RNs work 12+).


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## Tigger (May 5, 2013)

Bring this thread back on track or it's done.


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## JPINFV (May 5, 2013)

Tigger said:


> Bring this thread back on track or it's done.


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## VFlutter (May 5, 2013)

Ecgg said:


> If the patient goes in to cardiac arrest on your floor is RN allowed to initiate CPR? By that I mean prompt initiation of chest compression on your own accord? Because that is what this patient currently needs. Or you call the doctor? Or page/broadcast/announce/call response



Uh, what? I do not know any hospital in the country that does not allow floor RNs to start CPR. Even techs will start CPR if a patient arrests. When I code a patient I am usually through the first few rounds of ACLS before the code team even gets there. I don't sit there and wait for the doctor to show up before I start compressions. 

Actually, "call the doctor" is almost never the correct answer on standardized nursing exams.


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## ExpatMedic0 (May 5, 2013)

JPINFV said:


>



haha, ya how does this all tie in with the topic of nurses riding on FD transport ambulances?


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## Summit (May 5, 2013)

Ecgg said:


> In reality RN facade of management is calling the doctor or paging code "insert color of what your facility uses" and waiting for their response.
> 
> If the patient goes in to cardiac arrest on your floor is RN allowed to initiate CPR? By that I mean prompt initiation of chest compression on your own accord? Because that is what this patient currently needs. Or you call the doctor? Or page/broadcast/announce/call response team?
> 
> ...



Well, I think we have gone to the heart of the matter hear. Frankly, you are operating under either some completely incorrect assumptions, or your perspective has been limited to an unusually restrictive facility and you are extrapolating it to the rest of the world.

First I'll admit my perspective is limited to my first hand experience as an EMT, a nursing student, an ICU nurse, and to what my colleagues have related to me in other states and hospitals. I hope that I can share some perspective with you:

Yes, the ICU nurse is going to IABP controls (at many facilities at least, I know of one where it could be RT flying the IABP). I'm guess you also think RNs have to ask mother may I before giving O2. 

Yes, the nurse is going to initiate CPR without being told to do so, but not before hitting the code blue button and/or yelling "Bring the Code Cart NOW!!!" That is expected of a CNA, EMT, Paramedic, RN, or MD. At my facility, the RN is expected to have CPR in effect, the lifepack pads on and, if appropriate, to initiate the first shock all before the code team arrives. In the ICU, we will push atropine for symptomatic bradycardia if it is appropriate, and there are plenty of other RN practice policy privileges (something akin to protocols). When we run codes, we use a pilot/copilot model with the resident as the pilot and an ICU RN as the co-pilot.

Next, I'll share with you some information. Let's start with nursing exams: the answer is not always "call the doctor." Nursing is expected to assess, investigate, and problem solve as appropriate. In fact, turning off your brain and calling the doc for everything will get your reamed and fired. When you do call the physician, you are expected to be able to explain the situation, give the background and unnecessary findings, your assessment of the situation, and your recommendations on what should be done. SBAR (or ISBARR if you prefer). 

For example: I see PVCs in my patient who was otherwise in ST and the MAP is starting to drop. I adjust some vasoactive drips, assess, and elected to send scheduled coag and CBC labs early, and tacked on an ABG and lytes panel. I receive the results, THEN I called the resident, which went something like this: 

Me: "Hey Doc, this is Summit taking care of MICU bed X. There is some new ectopy and hemodynamics are requiring more aggressive use of pressors apparently from worsened coagulation and worsened hemorrhage with a continued acidosis. I saw some new polymorphic PVCs and so I sent the labs early, the H&H has now dropped to 6.5/20 and the PT/PTT/INR is now 70/85/8.9 and fibrinogen is less than 60. The iCa is 1.09 and Mg is 1.4. Also, we the profound acidosis continues and changing vent settings further is unlikely to help an uncompensated metabolic acidosis of 7.14, 20, 114, and 8.5. Can we please start a bicarb drip? It will help my pressors work too... and do some FFP, cryo, platelets, and PRBCs, and replete the Ca and Mg?"

Dr. So and So: "Crap. Yea. I'll order the blood products. Go ahead and push a gram of Ca and I'll write for the Mg. I like the bicarb idea, but I want to check with pulm first."

Me: "Sweet. I will push 1 gram of Ca, I'll look for the Mag bag, and I'll call blood bank to let them know the paperwork is forthcoming."

(and later there was a bicarb drip)



> Even though the Intensivist allowed you to come, but the charge admin RN’s think it’s highly inappropriate for a Medic to do an ICU rotation with the MD.


That is ridiculous. I am sorry that happened to you. It sounds like that facility was not very pro-education.



> RNs who’s employer paid them to attend and they complain how early they had to wake up.  Getting dirty stares from all the nurses when I am the only medic in the room after we do the introductions
> 
> I don’t expect RN’s to change their minds about ambulance drivers even though there are outliers and I don’t expect Paramedics to change their minds about nurses even though there are outliers. Will see if my outlook will change when I am in the medical student role, although honestly I think it will be worse.



It really sounds like you have an axe to grind here... I hope you can gain some perspective and peace on this issue. Perhaps you should try setting the example. If you go through medical school with disdain for nurses, it will not be to your advantage. Our chief of medicine never walks out of a patient room without asking for nursing input and constantly reminds residents to listen to and respect nurses.

Nursing isn't always right, but we are all on the same team, just with different jobs.

One thing I've learned as I've gone on is how much more there is to know and be an expert at than virtually any person can master, even within their own subfield. You realize that when dealing with complex problems in complex systems, the human element can muddy the waters. It is readily apparent when you see renowned cardiologists disagreeing among themselves, or the cardiothoracic surgeons going at it with the cardiologists, or the pulm/cc fellow ranting that if the medical attending would only listen to them then things would right.

ETA: While I was typing all that, Tigger posted.


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## Carlos Danger (May 5, 2013)

Ecgg said:


> The difference here is what "manage" actually entails. In CCT environment we work darn hard in the sending facility to make sure the patient and crew have an unadventurous trip.
> 
> If however patient condition deteriorates we don't have the luxury of recruiting higher trained members to gives us hands on assistance. In reality RN facade of management is calling the doctor or paging code "insert color of what your facility uses" and waiting for their response.
> 
> ...



It is always amusing to see people try to speak with authority on things with which they obviously have very little, if any, actual experience. :rofl:


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## Fish (May 5, 2013)

SFLfire said:


> Medics and EMTs have to do shifts in the ER and we're not really learning anything new in there



I have been in EMS for 8yrs, I like to think I have seen a lot, done a lot and know a thing or two. And I would sure benefit even now from a clinical in an ER or OR. There is SOOOOOOOOOO much a Medic student does not know, the clinical time should be expanding your mind. And as you move on in your career and become a more experienced provider the things you want to know, the questions you have they never stop, they just change and a lot of the time the answers are found in the ER. Saying a nurse can't teach you anything is like saying a Medic cannot teach a nurse anything, it is not true.



But to answer the original question of this thread, I think ER nurses benefit greatly from 2-3 ride outs. Infact 1 hosp out here does not require it, but has it as an option for all new er nurses....... And usually they take advantage of it and they have a good time and learn a few things.


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## Akulahawk (May 5, 2013)

Over the years, the nurses that I've met that bash the paramedics usually have no idea what they do or the training they actually do receive. From what I've seen during my nursing training is that they're given absolutely zero education about what other care providers are capable of and their general scopes of practice. RN's are taught about appropriate delegation to CNA and LVN staff... but not to EMT / AEMT / Paramedic personnel, which they lump into unlicensed personnel. 

Requiring a Nurse to ride on a Paramedic unit for a couple shifts and become familiar with prehospital protocols should at least give the Nurse a very basic understanding about an area they have little understanding of. Later on down the road, it'll also help them determine if the transfer/discharge via ambulance is actually appropriate, for instance.


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## chaz90 (May 5, 2013)

My old hospital based service often had ED nurses and other floor RNs ride along. It did seem to give them a bit of appreciation into what field work is like and what we do.


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## Akulahawk (May 5, 2013)

chaz90 said:


> My old hospital based service often had ED nurses and other floor RNs ride along. It did seem to give them a bit of appreciation into what field work is like and what we do.


That's a wonderful thing! They might not like or fully understand field work, but they'll at least realize it's a bit different than working in hospital...


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## hogwiley (May 6, 2013)

I'm still surprised how many RNs dont seem to know the difference between an EMT and Paramedic, even in the ER. Some seem to think Paramedic is just another name for EMT and we all just flip a coin to decide who does ALS or BLS that shift.


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## chaz90 (May 6, 2013)

hogwiley said:


> I'm still surprised how many RNs dont seem to know the difference between an EMT and Paramedic, even in the ER. Some seem to think Paramedic is just another name for EMT and we all just flip a coin to decide who does ALS or BLS that shift.



Most ED nurses I've seen at least have some concept of the difference, but you should have seen the looks on the faces of the Med/Surg floor staff when we showed up to intubate their patient on a Rapid Response Team call. 

*Not a dig at Med/Surg staff by any means. Simply a comment on how little exposure they have to EMS.


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## Rialaigh (May 6, 2013)

Not to stir the pot with all the RN/Paramedic blah blah....there are several undisputed facts that we in EMS need to remember when talking about our RN buddies

1. On Average, they are better trained, more educated, and have a better understanding of disease processes and treatments for anything that has a longer duration than running a code. They are required to have more underlying medical knowledge prior to specializing. They have more patient contact, more physician interaction, and much more experience being involved in patient care planning. I'm not saying medics are taxi drivers but when you haul someone in who is septic, the medic does about .1% of the work and the nurses and physicians and hospital support staff will do the other 99.9% to get that patient home with some quality of life left...

2. See number 1

3. See number 1 again


I don't care if they don't know the difference between an EMT and a paramedic as long as they are good at their job. I haven't met very many medics who are comfortable running a REACH (stroke) consult, or assisting in the cath lab, does that make us bad medics...no....*by the same note the majority of these RN's simply have no use at all, and would not benefit in any meaningful manner from ride time. *

The only exceptions to this are RN's operating in a emergency role without direct access to a physician, see flight RN's and critical care transport...


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## Achilles (May 6, 2013)

Where's clipper?


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## Clipper1 (May 6, 2013)

Achilles said:


> Where's clipper?



I have a life. I don't spend hours on a forum like this. I give a few minutes every 2 to 3 days and then I'm done. There are more forums which I am more interested in. This one just caught my interest since some of the issues discussed here do concern us in the hospital and on critical care transports.


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## Clipper1 (May 6, 2013)

hogwiley said:


> I'm still surprised how many RNs dont seem to know the difference between an EMT and Paramedic, even in the ER. Some seem to think Paramedic is just another name for EMT and we all just flip a coin to decide who does ALS or BLS that shift.



By the time we get EMT and Paramedic figured out another new title pops up. In WA we at one time had 7 different credentials between EMT and Paramedic.

We also have a list of what ambulance services can transport what. Even with the same title of Paramedic (or EMT) some can take certain drips and equipment and some can't.  You also can have EMTs on ALS trucks with expanded roles. You can also have someone with a Paramedic patch working on a BLS truck and can only do BLS with no drips or advanced equipment.


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## Clipper1 (May 6, 2013)

chaz90 said:


> Most ED nurses I've seen at least have some concept of the difference, but you should have seen the looks on the faces of the Med/Surg floor staff when we showed up to intubate their patient on a Rapid Response Team call.
> 
> *Not a dig at Med/Surg staff by any means. Simply a comment on how little exposure they have to EMS.



You listed one skill you can do.

Now how much do you know about Med/Surg nurses? Have you ever seen their standing protocols and listing of all of the procedures/skill they do? 

I guess if you showed up on any floor to intubate instead of regular staff I would have to ask why?


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## Aidey (May 6, 2013)

Clipper1 said:


> I guess if you showed up on any floor to intubate instead of regular staff I would have to ask why?



Have you considered that he is regular staff, is employed by the hospital and is a member the rapid response team?


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## Clipper1 (May 6, 2013)

Akulahawk said:


> Over the years, the nurses that I've met that bash the paramedics usually have no idea what they do or the training they actually do receive. From what I've seen during my nursing training is that they're given absolutely zero education about what other care providers are capable of and their general scopes of practice. RN's are taught about appropriate delegation to CNA and LVN staff... but not to EMT / AEMT / Paramedic personnel, which they lump into unlicensed personnel.



In hospitals EMT/AEMT/Paramedic will probably be unlicensed personnel because the state EMS boards write for prehospital licensure. EMTs are usually certified regardless.  If working in a hospital they will also be working under a different title like ER Tech.  Their EMT or Paramedic cert might be recommended at hire but some don't require them to keep it up especially after they get the necessary hospital certs or a national/state phlebotomy cert especially if they are doing more than what a PCT can do.  What this all means is that the RN would still be delegating by the same unlicensed personnel policy.  

This would be no different than if an RN who also held an EMT or Paramedic certification/license worked as an EMT or Paramedic for the fire department. The RN title should have no bearing especially in a fire department. For private ambulance companies where there might still be the issue of higher license or education when liability is an issue.


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## usalsfyre (May 6, 2013)

Clipper1 said:


> For private ambulance companies where there might still be the issue of higher license or education when liability is an issue.


Either it has bearing or it doesn't. One could easily argue a non-specialized RN is lesser educated when it comes to airway management or resuscitation. To automatically assume an RN is the "higher license" is hypocritical and smacks of the same type of provider bashing you accuse other of. You don't see Rad Techs, RRTs and RN's arguing over who's "higher" do you?


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## Clipper1 (May 6, 2013)

usalsfyre said:


> Either it has bearing or it doesn't. One could easily argue a non-specialized RN is lesser educated when it comes to airway management or resuscitation. To automatically assume an RN is the "higher license" is hypocritical and smacks of the same type of provider bashing you accuse other of. You don't see Rad Techs, RRTs and RN's arguing over who's "higher" do you?



If you are working in a hospital, your job title and job description will spell this out. 
If the EMT or Paramedic title is not recognized in the hospital and you are working under a different title, then you fall into the hierarchy for that title regardless of what you do on the ambulance.

Yes in the hospital there is a hierarchy between professionals depending on the circumstances and area. Each will also have their own job description and title. A Radiology Technologist with a Masters degree can oversee the Rad procedure but the patient will still be under the care of the RN who can also determine if a procedure should be stopped for the safety of the patient and for reasons which are out of the RTs area of expertise.  

There are also many allied professionals who are required to have an Associates degree but are not on the same level as RNs, RRT or RTs. 

PTA, OTA and some levels of Rad Technologists exist fall in a different level. There used to be a lower level in Respiratory also but I think they have gone by the wayside now or at least in this hospital.  But, even for them they have different job description levels such as I, II or III similar to RNs which their level of expertise and sometimes leadership roles must be observed.  All are also floated by their level of expertise and job description level. You would not put an RN I who has not ICU or ED experience in either area. 

Would you put an EMT or even a Paramedic who has only done routine IFT transports on a 911 truck to do lead or be senior?  I have known IFT Paramedics working on ALS transport trucks who have not started an IV or intubated in 5 years after joining that agency.  They still are Paramedics.  I think for Paramedics this might have a bigger influence since there is an expectation that all can do certain skills.  Assuming that just because it is in your scope of practice for the state does not necessary mean you can do it either.

RNs, or most, do understand that regardless if it is in their state scope, they may not always be able to do it in their job description and those who have seen what other RNs do in specific areas like the many ICUs, they must have additional training and education.


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## ExpatMedic0 (May 6, 2013)

usalsfyre said:


> Either it has bearing or it doesn't. One could easily argue a non-specialized RN is lesser educated when it comes to airway management or resuscitation. To automatically assume an RN is the "higher license" is hypocritical and smacks of the same type of provider bashing you accuse other of. You don't see Rad Techs, RRTs and RN's arguing over who's "higher" do you?



+1 to this
Is anyone else having VentMedic flashbacks?


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## Achilles (May 6, 2013)

Clipper1 said:


> I have a life. I don't spend hours on a forum like this. I give a few minutes every 2 to 3 days and then I'm done. There are more forums which I am more interested in. This one just caught my interest since some of the issues discussed here do concern us in the hospital and on critical care transports.


Oh you do have a life, I was thinking you were a bot that was replying, silly me. :wacko:
I'm glad you answered a rhetorical question, would it be too much of a burden to answer my other one?


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## Ecgg (May 6, 2013)

Summit said:


> Ecgg: I hope you are only letting Clipper1's abrasive attitude drive your silly response. If so, rise above your emotions. I hope that you are not really that misinformed about the capabilities and regular practices of ICU nurses. If you think RNs are for "recording notes" and don't know anything about diagnosis, you need some perspective. Sure, RNs do not "diagnose"... just like paramedics don't "diagnose."



Sometimes it requires one to resort to ignorant extremes to show hypocrisy of one side toward the other.  This was clearly evident by all the replies that ensued, yet Clipper1 states these things about medics and emts like it’s gospel and goes unchecked. 

I certainly acknowledge Paramedics/ EMT’s education in critical care arena is very limited, actually none existent would be a better word.  Even with my very limited ICU experience I have certainly interacted with exceptional Nurses who were instrumental to my current knowledge and helped me with the patient and with whom I consult every single time.  I recently took a ICU class which was led by a ICU RN, and the presentation was excellent probably the best course I have ever took and it helped me put a lot of things I read in literature into perspective.  I certainly always listen to nurses’ reports, and any information they are willing to share.  Everyone pays a pivotal role in care of patients regardless of the initials after your name.  

Hence why these debates RN vs Medics etc. are seldom productive. I much rather discuss solutions on how to advance education, what classes to take, what to read and improve paramedics limited ICU exposure. If we tackled clinical topics and how to address education with such vigor as we do RN vs Paramedic class hierarchy there would be many more people directed to proper resources and education.


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## NomadicMedic (May 6, 2013)

Folks, this thread is getting very far off topic and coming very close to some personal attacks. Rein it in please. 

Remember, the "first rule" is be polite.


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## JPINFV (May 7, 2013)

DEmedic said:


> Folks, this thread is getting very far off topic and coming very close to some personal attacks. Rein it in please.
> 
> Remember, the "first rule" is be polite.




Coming close to personal attacks? How about we go back and reread the passive aggressive personal attacks that Clipper is flinging, mmkay?


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## BandageBrigade (Jun 7, 2013)

Clipper1 said:


> In hospitals EMT/AEMT/Paramedic will probably be unlicensed personnel because the state EMS boards write for prehospital licensure. EMTs are usually certified regardless.  If working in a hospital they will also be working under a different title like ER Tech.  Their EMT or Paramedic cert might be recommended at hire but some don't require them to keep it up especially after they get the necessary hospital certs or a national/state phlebotomy cert especially if they are doing more than what a PCT can do.  What this all means is that the RN would still be delegating by the same unlicensed personnel policy.
> 
> This would be no different than if an RN who also held an EMT or Paramedic certification/license worked as an EMT or Paramedic for the fire department. The RN title should have no bearing especially in a fire department. For private ambulance companies where there might still be the issue of higher license or education when liability is an issue.



I suggest you do some research before making blanket statements. I am licensed and I work in an ER. My title is Paramedic, no ER tech. I work alongside the nurses in the ER and the work alongside me. neither of us is 'higher' than the other. In my state we are considered licensed and as such can work in any health care facility or setting.


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## Clipper1 (Jun 7, 2013)

BandageBrigade said:


> I suggest you do some research before making blanket statements. I am licensed and I work in an ER. My title is Paramedic, no ER tech. I work alongside the nurses in the ER and the work alongside me. neither of us is 'higher' than the other. In my state we are considered licensed and as such can work in any health care facility or setting.



Post your state and the statute.

Here is one example.  

http://www.llr.state.sc.us/POL/Nursing/AdvisoryOp/AO49.pdf



> The Board of Nursing for South Carolina recognizes that it is NOT within the role and scope of the registered nurse (RN) or licensed practical nurse (LPN) to supervise emergency medical technicians (EMTs) and paramedics in the emergency department (ED) while functioning as an EMT or paramedic. In the state of South Carolina, the Department of Health and Environmental Control (DHEC), Division of Emergency Medical Services (EMS), authorizes EMTs and paramedics to perform certain described procedures and acts. They perform these procedures and acts while employed by a licensed Emergency Medical Services provider and under the guidance of an approved Medical Control physician. *The EMT or paramedic certification does not apply within a medical facility or agency. EMTs and paramedics are not allowed to wear any designation of such certification while working as an employee within a healthcare facility or hospital. When employed by the hospital or healthcare facility, they should follow the guidelines for unlicensed assistive personnel related to nursing supervision and oversight.
> 
> *



Texas

http://www.bon.texas.gov/practice/faq-paramedics.html



> The rules governing EMTs and Paramedics are located in Title 25, Texas Administrative Code, Section 157.2. This rule limits the scope of practice of EMTs/Paramedics to performing duties in the "pre-hospital and inter-facility transport" settings. Therefore, whether certified or licensed, the BON delegation rules view EMTs, Paramedics, or other similarly trained staff as "unlicensed assistive personnel" (UAPs) when working in acute care settings, such as the ED.



Kentucky

http://kbn.ky.gov/NR/rdonlyres/989D2CE9-B548-44E0-825C-4F6E2ACA6AB1/0/aos15.pdf



> A Registered Nurse may delegate a task to a Paramedic employed in a hospital Emergency Department....




At your job, can you manage a patient who is admitted to ICU but is still in the ICU? An ICU ventilator? Hang blood? Give all the same pressors as an RN?   If so it sounds like you hospital is working on the cheap. This is not something I would brag about since you are being used.  Just remember your prehospital immunity will not apply in a hospital.


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## BandageBrigade (Jun 7, 2013)

Clipper1 said:


> At your job, can you manage a patient who is admitted to ICU but is still in the ICU? An ICU ventilator? Hang blood? Give all the same pressors as an RN?   If so it sounds like you hospital is working on the cheap. This is not something I would brag about since you are being used.  Just remember your prehospital immunity will not apply in a hospital.



Yes (I assume you mean admitted but still in ED) Yes, but in all fairness whether a nurse or medic has this patient an RT will handle vent work majority of the time if available. Yes,  and Yes.  How are we being used? We earn the same wage as the ED RN.   What "prehospital immunity" are you referring to?

I will post statue as soon as I get home.


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## Clipper1 (Jun 7, 2013)

BandageBrigade said:


> Yes (I assume you mean admitted but still in ED) Yes, but in all fairness whether a nurse or medic has this patient an RT will handle vent work majority of the time if available. Yes,  and Yes.  How are we being used? We earn the same wage as the ED RN.   What "prehospital immunity" are you referring to?
> 
> I will post statue as soon as I get home.




I really want to know what hospital does this. Do the RNs not have nursing levels for skills and pay grades?  What is the point of spending 4 years in college if they can do the same stuff in 1 year?  I guess that could be another discussion.

Once a patient is "admitted" to the ICU, an ICU qualified or cross trained RN will care for them. There is also much more than just the ventilator since ICU protocols will be initiated.  RT is also not around in the ER except for vent set up and transport to other areas.  But, having RT around does not excuse an RN from not having a competency on that ventilator.  Anybody can turn a knob or babysit a ventilator but only those who have knowledge of the meds and the care of this type of patient should be caring for them. The same for an IABP or any other accessory or medication attached to the patient.


EMS immunity:
http://www.emsworld.com/article/10323938/immunity-statutes-how-state-laws-protect-ems-providers

There have been a couple places which have extended this immunity to ER staff in the hospital.


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## BandageBrigade (Jun 7, 2013)

Clipper1 said:


> I really want to know what hospital does this. Do the RNs not have nursing levels for skills and pay grades?  What is the point of spending 4 years in college if they can do the same stuff in 1 year?  I guess that could be another discussion.
> 
> Once a patient is "admitted" to the ICU, an ICU qualified or cross trained RN will care for them. There is also much more than just the ventilator since ICU protocols will be initiated.  RT is also not around in the ER except for vent set up and transport to other areas.  But, having RT around does not excuse an RN from not having a competency on that ventilator.  Anybody can turn a knob or babysit a ventilator but only those who have knowledge of the meds and the care of this type of patient should be caring for them. The same for an IABP or any other accessory or medication attached to the patient.
> 
> ...



Sorry. I will not be posting the name of the hospital I work in. Yes, there are pay levels, But they are based off of education and experience. So a brand new Associates degree RN makes the same as a brand new Associates degree Paramedic. 

Things are not the same in every hospital as they are in your hospital. Just because your hospital does not have a dedicated RT does not mean others do not. ER and ICU have a dedicated RT each every shift. There is also an RT to cover the rest of the hospital/floors. ER RT is on call for OB/premies. They rotate through assignments. ER RNs and Medics all go through competencies on ICU specific equipment every quarter in case they have to "babysit" until patient gets moved up or transferred. IABPs are not placed in our ED setting.


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## Clipper1 (Jun 7, 2013)

BandageBrigade said:


> Sorry. I will not be posting the name of the hospital I work in. Yes, there are pay levels, But they are based off of education and experience. So a brand new Associates degree RN makes the same as a brand new Associates degree Paramedic.



I take your post to mean this hospital is not striving for Magnet status.


Our hospital has a few RTs but that does not excuse nursing personnel in the ER who want to care for ICU admit patients from taking the training as if they were working in the ICU. 

Do Paramedics also work in the ICUs?

I am not trying to be antagonistic but, why spend 2 years in college to get a "prehospital" degree if you could get an ADN which is apparently still acceptable for new hires in your facility?  Wouldn't it make more sense to get the RN if you want to work in the hospital and have more opportunities available when you get tired of the ER?   You are doing the same job but the Paramedic will have less flexibility t/o the health care system.

We sometimes get LVADs and IABPs from transports to be parked until they are ready in the pre op room or ICU.


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## BandageBrigade (Jun 7, 2013)

Clipper1 said:


> I take your post to mean this hospital is not striving for Magnet status.
> 
> 
> Our hospital has a few RTs but that does not excuse nursing personnel in the ER who want to care for ICU admit patients from taking the training as if they were working in the ICU.
> ...



They are, but staffing needs can out weigh that. There are very good incentives for RNs and Medics to achieve a bachelors or higher. Less than associates medics are not hired. It would make sense to initially get your RN and have more opportunities and flexibility, I agree with you there 100%. Hindsight. 

You are also correct, it does not excuse medics and nurses from ICU education and training, which is a mandate to keep up on.


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