# Nurses Balking About Proposed Calif. Paramedicine Program



## atropine (Aug 13, 2014)

Nurses Balking About Proposed Calif. Paramedicine Program 

Aug. 12--Paramedics could have a bigger say over where 911 emergency patients are treated and aid in their recovery after hospitalization under a proposal to expand their health care roles -- a move opposed by nurses unions.

So are any other communities having this problem?


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## Angel (Aug 13, 2014)

the link doesnt come up right (for me) but i know what you are referencing. i dont know why nurses would want MORE work, but its just more fuel to the nurse v medic debate.
no issue here, yet as community paramedicine hasnt taken off  here


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## Akulahawk (Aug 13, 2014)

I would imagine that nurses are going to push very hard against projects like that. In a sense, they're right. Paramedics don't have the training that the nurses do as far as mental and public health. When they claim that "even with additional education" they still would lack the ability to do the job is essentially saying that Paramedics can't learn anything new. Mostly, the nurses don't want to give up anything to any other care provider. Their job isn't going to change. There's not enough of them to actually do the job that these Paramedics are doing, or there wouldn't be a need to have them. 

Overall, I really don't see much of an issue because the nurses aren't doing the same job that the Paramedics are doing.


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## chaz90 (Aug 13, 2014)

I don't care who ends up doing this job, but the fact is someone should be. If nurses want to fill in this niche and call themselves "Community Nurses" or whatever other term they want to use, more power to them. Otherwise, they'll have to step aside to let someone else do it. No one is suggesting taking a paramedic straight from our existing paramedic programs and placing them in this role. Of course they would be woefully unprepared for something they never trained to do. Done in the right way with the right people with the right educational foundation, I hope this continues to gain traction and makes a difference.


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## Rialaigh (Aug 14, 2014)

chaz90 said:


> I don't care who ends up doing this job, but the fact is someone should be. If nurses want to fill in this niche and call themselves "Community Nurses" or whatever other term they want to use, more power to them. Otherwise, they'll have to step aside to let someone else do it. *No one is suggesting taking a paramedic straight from our existing paramedic programs and placing them in this role*. Of course they would be woefully unprepared for something they never trained to do. Done in the right way with the right people with the right educational foundation, I hope this continues to gain traction and makes a difference.



This is where nurses really have complaints, In fact many paramedics and many EMS directors are advocating taking paramedics right now and placing them in that role with nothing more then a 16 hour in house "community paramedicine" course.


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## JPINFV (Aug 14, 2014)

Rialaigh said:


> This is where nurses really have complaints, In fact many paramedics and many EMS directors are advocating taking paramedics right now and placing them in that role with nothing more then a 16 hour in house "community paramedicine" course.



So it's like the 2 year part time online courses where half of the information is fluff (admin, "capstone project," "nursing theory"), calling them a nurse practitioner, and saying that they're equal to physicians? 

I think the comeuppance are ready to come out of the oven.


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## TransportJockey (Aug 14, 2014)

Rialaigh said:


> This is where nurses really have complaints, In fact many paramedics and many EMS directors are advocating taking paramedics right now and placing them in that role with nothing more then a 16 hour in house "community paramedicine" course.


NM must be ahead of the curve for once. Here it's being pushed through legislation for a community paramedic certification on top of the existing four levels. And the schools teaching it in the state require at least two years ALS and its a two semester course with minimum 400 hours clinical time (I'm in tbe first class at one of the state colleges)


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## kal0220 (Aug 14, 2014)

It would be nice to be given the option to transport a routine or non-emergent patient to an urgent care facility v/s the ER every time a pt wants to be transported.


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## samiam (Aug 14, 2014)

I think this isba good idea, there are already such great abuses of the system this will relieve some preassure. Frankly I think every city should have a few community ambulances that are staffed with paramedics and nurse practitioners or PA's with medical supples and a mini pharmacy that can treat and release minor things.


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## Akulahawk (Aug 14, 2014)

TransportJockey said:


> NM must be ahead of the curve for once. Here it's being pushed through legislation for a community paramedic certification on top of the existing four levels. And the schools teaching it in the state require at least two years ALS and *its a two semester course with minimum 400 hours clinical time* (I'm in tbe first class at one of the state colleges)


That's a whole lot more than a 16 hour course.


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## gonefishing (Aug 14, 2014)

I'm shocked the fire unions not fighting it? Or does this just give another reason for station upgrades, new pumpers and ladders?


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## Carlos Danger (Aug 14, 2014)

Rialaigh said:


> This is where nurses really have complaints, In fact many paramedics and *many EMS directors are advocating taking paramedics right now and placing them in that role with nothing more then a 16 hour in house "community paramedicine" course.*



Exactly.

The community paramedicine concept is a great opportunity for the field of paramedicine to bring itself out of the stone ages, help fill a huge gap in healthcare, and create much better career opportunities for paramedics.

But in order for it to work, we have to take the responsibility of the role seriously. It's gonna require real education and accountability. And acceptance of significantly more responsibility than paramedics currently have.




JPINFV said:


> *So it's like the 2 year part time online courses where half of the information is fluff* (admin, "capstone project," "nursing theory"), calling them a nurse practitioner, and saying that they're equal to physicians?



If you know where a 2 year, part time, entirely online NP program exists, I'd love to hear about it, as I'm sure would some others on the forum. Please share.


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## Carlos Danger (Aug 14, 2014)

error


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## TransportJockey (Aug 14, 2014)

Akulahawk said:


> That's a whole lot more than a 16 hour course.


Lol yep. More like 21 CREDIT hours


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## JPINFV (Aug 14, 2014)

Remi said:


> If you know where a 2 year, part time, entirely online NP program exists, I'd love to hear about it, as I'm sure would some others on the forum. Please share.



http://online.nursing.georgetown.edu/academics/academics-overview/

...and 2 on campus visits in 2 years is essentially completely online. Call it a vacation, especially when those 2 vacations makes are supposed to make an NP equal to a residency trained physician capable of unsupervised medical practice.


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## Carlos Danger (Aug 15, 2014)

JPINFV said:


> ...and 2 on campus visits in 2 years is essentially completely online. Call it a vacation, especially when those 2 vacations makes are supposed to make an NP equal to a residency trained physician capable of unsupervised medical practice.



Georgetown's ACNP program, while described in their literature as "part time", requires an average of 7 credit hours per semester (which is actually very close to a full-time graduate course load) across the 24 month program and includes 900 hours of clinical experience. Their FNP program requires fewer credits (44 instead of 48) and clinical hours (650) but still works out to a full time course load for 19 months or 6 hours per semester for the 27 month part-time option.

Vanderbilt, Northeastern University, and Univ of Alabama are a few of the other well-respected institutions that have very similar programs. 

Not sure I'd call 900 clinical hours over 24 months or 650 over 19 months "completely online". Especially considering that it's very common for RN's to continue working full-time while in these programs. 

A very different (and arguably much more innovative) educational model than that used in medicine to be sure, but not exactly the cracker-jack box degree that you make it sound like.


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## JPINFV (Aug 15, 2014)

Remi said:


> but not exactly the cracker-jack box degree that you make it sound like.


Actually, to declare an FNP to be equivalent to a board certified family physician (and there's more than enough NPs out there ready to do that), it very much is a cracker-jack box degree when compared to 4 years of medical school and 3 years of residency.


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## Carlos Danger (Aug 15, 2014)

JPINFV said:


> Actually, to declare an FNP to be equivalent to a board certified family physician (and there's more than enough NPs out there ready to do that), it very much is a cracker-jack box degree when compared to 4 years of medical school and 3 years of residency.



Sorry to hear that you have so little respect for your non-physician colleagues.

I have no desire to get dragged into a APN vs. MD debate, especially in a thread about an exciting horizon in paramedicine. I would refer anyone who IS interested in such to the many outcomes studies which have been done on the topic. Like every other area of healthcare, what the research reveals is often very different than what we assume to be true. 

I was simply pointing out the errors in your description of Georgetown's NP programs.


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## StudMartin (Aug 15, 2014)

JPINFV said:


> Actually, to declare an FNP to be equivalent to a board certified family physician



Who said they were?  Clearly they have separate roles and starkly different training.  Anyone arguing that an APRN is equivalent to an MD/DO is misinformed, and in the minority.

That said, NPs (and PAs for that matter) are typically very well trained and competent providers.


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## JPINFV (Aug 15, 2014)

nikc12 said:


> Who said they were?  Clearly they have separate roles and starkly different training.  Anyone arguing that an APRN is equivalent to an MD/DO is misinformed, and in the minority.
> 
> That said, NPs (and PAs for that matter) are typically very well trained and competent providers.


Well, the government for one... https://www.thelundreport.org/content/nurse-practitioner-pay-equity-easily-passes-house

Nurses for another... http://allnurses.com/nurse-practitioners-np/np-md-equivalency-316413.html


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## JPINFV (Aug 15, 2014)

Remi said:


> Sorry to hear that you have so little respect for your non-physician colleagues.



Recognizing that the education of one isn't equal to the other isn't having "so little respect" it's recognizing that there's a difference in education. Furthermore, I don't recognize "nursing experience" as a substitute for medical school, which is exemplified every time I get paged to authorize shoving a K-dur down a patient's neck for a potassium value of 3.4. 



> I have no desire to get dragged into a APN vs. MD debate, especially in a thread about an exciting horizon in paramedicine. I would refer anyone who IS interested in such to the many outcomes studies which have been done on the topic. Like every other area of healthcare, what the research reveals is often very different than what we assume to be true.


You mean like the studies that show they order more tests than even a physician in residency?
Or the fact that the exam developed for them as a watered down Step 3 had half of the applicants failing? There's value in having a general understanding of medicine and THEN specializing. There's a reason even orthopods have to have a general understanding in medicine, regardless of how much they get ragged on. 




> I was simply pointing out the errors in your description of Georgetown's NP programs.


How many medical schools are set up in a way to allow students to work part time while attending? There's a reason for that...


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## Uclabruin103 (Aug 16, 2014)

I'm confident now that I can successfully determine whether someone just released from the ER needs immediate transport back. That's what we do. Triage people and do physical assessments to determine our treatment. Now as far as long term treatment of chronic issues?  I can't speak for everyone but I know my medic training didn't touch on that at all. 

I don't see why a nurse wouldn't want to use us in this role together. We can have the flexibility to work under standing orders for immediate interventions while they could take care of the long term care.

I'm curious what everyone thinks would be enough education for medics to take this role, and what would we be learning. It's one thing saying we need education, but in what?


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## Carlos Danger (Aug 16, 2014)

Uclabruin103 said:


> I'm confident now that I can successfully determine whether someone just released from the ER needs immediate transport back. That's what we do. Triage people and do physical assessments to determine our treatment. *Now as far as long term treatment of chronic issues?  I can't speak for everyone but I know my medic training didn't touch on that at all.*
> 
> *I don't see why a nurse wouldn't want to use us in this role together.* We can have the flexibility to work under standing orders for immediate interventions while they could take care of the long term care.
> 
> I*'m curious what everyone thinks would be enough education for medics to take this role*, and what would we be learning. It's one thing saying we need education, but in what?



Anytime a labor union has a strong opinion on something, it's a very safe bet that their motivation is protectionist. That is to say, they don't like the idea of community paramedicine because they feel there is the potential for it to negatively affect employment opportunities for nurses. 

Some nursing organizations and individual nurses, however, have very legitimate concerns about patient safety, given the fact that the current paramedic curriculum provides exactly ZERO preparation for community health activity. I assume there are plenty of physicians who feel similarly. 

Remember that nurses are the largest group of healthcare professionals in the US and are therefore a major stakeholder in any major healthcare paradigm. Also remember that nurses have basically been the sole providers of community healthcare for decades.

A big part of the problem here is that it's difficult to talk about something that hasn't even been defined. What does "community paramedicine" even mean? Does it simply mean giving paramedics more power to refuse inappropriate transports and instead provide some very basic primary care and refer the patient to a clinic? Or are we talking about providing post-op wound care and rehab to patients who have no way to get to their doctor for follow-up? The former is the type of thing that should already be part of a paramedics training and scope, IMO. Concerning the latter, though, I think a really solid argument can be made that it makes much more sense to further invest in the community health nursing framework that already exists, rather than go to the trouble and expense of creating new educational programs for paramedics to do what nurses already do.


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## SandpitMedic (Aug 16, 2014)

JPINFV said:


> So it's like the 2 year part time online courses where half of the information is fluff (admin, "capstone project," "nursing theory"), calling them a nurse practitioner, and saying that they're equal to physicians?
> 
> I think the comeuppance are ready to come out of the oven.


+1


(We agree on something.)


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