There is nothing more irritating than incompetent nurses...

[mycrofft]

"Critical Care Paramedic" equals "We're paying someone less to do most of the work of a RN or other higher paid professional".

 

[46Young]

Are they using a standard curriculum like the FP-C or the UMBC CCEMTP program?

Either way it doesn't matter for this discussion, neither are recognized.

If they have their own program, I suspect the use of the CC is just a way to identify paramedics who have been locally upskilled by the authority of local/regional medical direction.

That method is really no different than the practice of local medical autonomy, similar to places like Texas.

Outside of your jurisdiction, it really doesn't mean crap.

As far as I know, there's no requirement, be it legal or for reimbursement purposes, to be a CCEMT-P in order to run certain types of calls. For example, at a local IFT service, there are no CC medics, so the medics can do anything within the scope of their practice so long as the sending MD gives written orders to that effect. PALS is also not required until six month after hiring, so that goes to show that the alphabet certs are not required, either.

I worked for North Shore LIJ, but I didn't go throught their CC program. The reason is, once you're a CC medic, you're no longer allowed to work in the 911 system (unless for OT), so you're basically an IFT medic 100% of the time. So, I can't compare the NY curriculum to the ones in VA.

I see the CCEMT-P cert as a band aid for the lack of clinical education in the U.S. Paramedic original program/degree, nothing more. I suppose employers feel that they're a little more safe letting medics handle vented/sedated w/ propofol titration, titrating ntg drips, etc. if they have the CC cert. Same for alphabet certs. If you have a mentally challenged medic working for you, hopefully they can run an ACLS protocol, even if they're clueles otherwise. All these alphabet certs are just to band aid an inadequate education system in our field, IMO.

 

[BandageBrigade]

"Critical Care Paramedic" equals "We're paying someone less to do most of the work of a RN or other higher paid professional".

What is with you and being down on the paramedic profession? You had a bad experiance as an emt? That sucks. The medics in your area suck? Thats unfortunate. As a "CCP" in the hospital based system at my part time gig, I make the exact same as my nursing counterparts. I also have the same job description when not on transport. Your (nor my) individual experiances do not hold true for everywhere.

 

[mycrofft]

Agreed, experiences are not universally good or bad, and kudos that they are paying you what you are worth! (Is there a chance they are paying your professional coworkers less because you are there?).

I work with local paramedics in community projects involving EMS, I've seen their work, and I have little/no complaints.

I'm not "down" on paramedics (or I don't feel down on them, especially since I'm not "up" enough to be "down" on a real one), I'm negative about the following:
1. People discriminating against other people based upon the letters after their name on their name badge. (Ironic? I think not...).
2. People wanting to find a back door to using higher levels of technique without more and thorough education.
3. Employers using any means to keep pay and benefits down for qualified people, and utilizing techs in professional roles by writing or buying voluminous protocols is one means they use to do that.

My bad experiences were not with paramedics, but with nurses when I was an EMT-A (now "B"). Now I'm a (retired) nurse, and when I was active I was always an advocate for fair treatment of techs by professionals. I also could spot a "cowboy", be they nurse/doc/tech, and had to work to retain professionalism sometimes.

I started the thread elsewhere proposing the concept that paramedics ought to be abolished in favor of Physician Assistants taking over their duties, having a higher level of training (supposedly), not because I am against paramedics, but because the lack of structure in the titling/credentialing thing is distressing.

(My thought about CC Paramedic: not a paramedic. A CC Tech would be the proper nomenclature, since EMT-Paramedic is the NHTSA-originated title for a PREHOSPITAL advanced life support tech. This seems picayune, but the professional/technician deal means more when you get to organizing labor and drawing up contracts).

Hope that makes things less snaggy.

 

[DrankTheKoolaid]

Agreed, experiences are not universally good or bad, and kudos that they are paying you what you are worth! (Is there a chance they are paying your professional coworkers less because you are there?).

I work with local paramedics in community projects involving EMS, I've seen their work, and I have little/no complaints.

I'm not "down" on paramedics (or I don't feel down on them, especially since I'm not "up" enough to be "down" on a real one), I'm negative about the following:
1. People discriminating against other people based upon the letters after their name on their name badge. (Ironic? I think not...).
2. People wanting to find a back door to using higher levels of technique without more and thorough education.
3. Employers using any means to keep pay and benefits down for qualified people, and utilizing techs in professional roles by writing or buying voluminous protocols is one means they use to do that.

My bad experiences were not with paramedics, but with nurses when I was an EMT-A (now "B"). Now I'm a (retired) nurse, and when I was active I was always an advocate for fair treatment of techs by professionals. I also could spot a "cowboy", be they nurse/doc/tech, and had to work to retain professionalism sometimes.

I started the thread elsewhere proposing the concept that paramedics ought to be abolished in favor of Physician Assistants taking over their duties, having a higher level of training (supposedly), not because I am against paramedics, but because the lack of structure in the titling/credentialing thing is distressing.

(My thought about CC Paramedic: not a paramedic. A CC Tech would be the proper nomenclature, since EMT-Paramedic is the NHTSA-originated title for a PREHOSPITAL advanced life support tech. This seems picayune, but the professional/technician deal means more when you get to organizing labor and drawing up contracts).

Hope that makes things less snaggy.

Why is a paramedic considered a "tech" and not a professional in your eyes when some of us completed the exact same pre-requisite coursework as ADN/ASN nurses? And with the exception of MICU/ICU/STICU/ED RN's I know, actually attempt to continue learning, instead of just settling in and being happy as the MD's puppet taking orders.

Were not the jack of all trades master of none like an RN, but we are masters of emergent pre-hospital care as we should be. Let see that wide bottom NOC RN that is considered a professional even consider putting herself out into a unfamiliar situation and gladly accept the challenge. You as well as I know that isn't going to happen.

 

[BandageBrigade]

Agreed, experiences are not universally good or bad, and kudos that they are paying you what you are worth! (Is there a chance they are paying your professional coworkers less because you are there?) Pay is comparable to other hospitals similar in size with equal services offered.(My thought about CC Paramedic: not a paramedic. A CC Tech would be the proper nomenclature, since EMT-Paramedic is the NHTSA-originated title for a PREHOSPITAL advanced life support tech. This seems picayune, but the professional/technician deal means more when you get to organizing labor and drawing up contracts). CCP (In Iowa at least) Is a state recognized endorsement available to paramedics, any extra scope of practice that it gives you only applys in the hospital setting or during interfacility transport.

Hope that makes things less snaggy.

See bolded text.

 

[TatuICU]

In theory isn't that the role of the clinical nurse specialist?

I am rather inquisitive, I would be interested, passed the basic A&P/pharm and some technical skills, what are you doing for these patients that c/t surg and cards intensive medicine isn't?

I don't get your meaning, we are the CVICU. And what are we doing? Well after the patient is closed, they are wheeled up the hill to us where we recover them from anesthesia (PACU does not do CV surgical cases), get them hemodynamically stabilized (because the anesthesiologist "isn't" bumping them with phenylephrine and their pressures "don't" tank 15 minutes after they sign off the case), wean them off the vents (we generally have 2 RTs for the hospital outside ER on duty for the hospital at night), and get them up and moving ASAP. Oh and I should mention these patients are off one to one care in 8 hours and you get to pick up another patient shortly thereafter if not 2.

So again, not sure what you mean. After the OR closes them, the patient is ours, there is no go between.

 

[TatuICU]

Were not the jack of all trades master of none like an RN

I take offense to that. Our CVICU nurses are all board certified and are all VERY well trained and capable. Not sure why you think medics are somehow more specialized. I do both and if anyone has to be a jack of all trades, its a medic

 

[DrankTheKoolaid]

re

Thats why I put the disclaimer about the specialized RN staff. Sorry mate maybe that didn't come off as clear as I had hoped

 

[NYMedic828]

I take offense to that. Our CVICU nurses are all board certified and are all VERY well trained and capable. Not sure why you think medics are somehow more specialized. I do both and if anyone has to be a jack of all trades, its a medic

Honestly, with Nurses or medic, its hit or miss with everyone.

There are plenty of medics who are absolute morons but are able to maintain certification and the same goes for nurses.

Half the city hospitals hire nurses who are off the boat from jamaica and have no clue whats going on here but at the same time they also hire very knowledgeable and capable nurses who I get along great with.

The issue that brought about starting this thread, was that at this particular hospital, they treat all EMS as if we don't matter and just want us to drop off our patient and leave without a word. It is a north shore hospital for those familiar with the region and they like to act like they are better than everyone else.

 

[TatuICU]

Thats why I put the disclaimer about the specialized RN staff. Sorry mate maybe that didn't come off as clear as I had hoped

I see that now, I apologize.

 

[Handsome Robb]

The whole nurse vs. medic argument has been beaten to death. Like NY said, both subsets have a wide variety of providers. Through my medic clinicals I have worked with nurses that have made me do double takes and have to reset my brain to comprehend what they just said and there are nurses that I have learned a ton from.

Nurse vs. medic makes no sense. They are two totally different specialties.

 

[DrankTheKoolaid]

re

If that was directed at me, I was not bringing that old argument up. That was a direct question to Mycroft as to his opinion why 1 is considered a professional in his eyes VS the other as a tech.

 

[Veneficus]

As far as I know, there's no requirement, be it legal or for reimbursement purposes, to be a CCEMT-P in order to run certain types of calls. For example, at a local IFT service, there are no CC medics, so the medics can do anything within the scope of their practice so long as the sending MD gives written orders to that effect. PALS is also not required until six month after hiring, so that goes to show that the alphabet certs are not required, either.

I worked for North Shore LIJ, but I didn't go throught their CC program. The reason is, once you're a CC medic, you're no longer allowed to work in the 911 system (unless for OT), so you're basically an IFT medic 100% of the time. So, I can't compare the NY curriculum to the ones in VA.

I see the CCEMT-P cert as a band aid for the lack of clinical education in the U.S. Paramedic original program/degree, nothing more. I suppose employers feel that they're a little more safe letting medics handle vented/sedated w/ propofol titration, titrating ntg drips, etc. if they have the CC cert. Same for alphabet certs. If you have a mentally challenged medic working for you, hopefully they can run an ACLS protocol, even if they're clueles otherwise. All these alphabet certs are just to band aid an inadequate education system in our field, IMO.

That is my take on it too.

 

[Handsome Robb]

If that was directed at me, I was not bringing that old argument up. That was a direct question to Mycroft as to his opinion why 1 is considered a professional in his eyes VS the other as a tech.

Wasn't directed at anyone in particular. Just adding my thoughts to a previous statement.

Sorry I'm a little out of it, stomach flu dealt me a swift kick in the *** this week.

 

[BandageBrigade]

As far as I know, there's no requirement, be it legal or for reimbursement purposes, to be a CCEMT-P in order to run certain types of calls. For example, at a local IFT service, there are no CC medics, so the medics can do anything within the scope of their practice so long as the sending MD gives written orders to that effect. PALS is also not required until six month after hiring, so that goes to show that the alphabet certs are not required, either.

I worked for North Shore LIJ, but I didn't go throught their CC program. The reason is, once you're a CC medic, you're no longer allowed to work in the 911 system (unless for OT), so you're basically an IFT medic 100% of the time. So, I can't compare the NY curriculum to the ones in VA.

I see the CCEMT-P cert as a band aid for the lack of clinical education in the U.S. Paramedic original program/degree, nothing more. I suppose employers feel that they're a little more safe letting medics handle vented/sedated w/ propofol titration, titrating ntg drips, etc. if they have the CC cert. Same for alphabet certs. If you have a mentally challenged medic working for you, hopefully they can run an ACLS protocol, even if they're clueles otherwise. All these alphabet certs are just to band aid an inadequate education system in our field, IMO.

I know we bill ours, as do most others that use it in the state, as a specialty transport and it is at a higher rate. That is for if a CCP or RN or RT or Doc comes along. I am not sure of its actually classification designation.

 

[usalsfyre]

I take offense to that. Our CVICU nurses are all board certified and are all VERY well trained and capable. Not sure why you think medics are somehow more specialized. I do both and if anyone has to be a jack of all trades, its a medic

Just like I'm board certified by the BCCTPC in critical care transport medicine?

While most of (not all) of the medicine is similar, the logistics of coming into and transporting a train wreck of a critically ill, technology dependent patient who may or may not have been sub-optimally managed with one or two providers in moving vehicle are vastly different than caring for them in the in-hospital environment. It's an exercise in planning ahead and at times improvisation and knowledge of alternatives. This is where an experienced and knowledgeable transport paramedic (or nurse) is worth their weight in gold.

Could the average ICU nurse be trained to do this competently? Most likely yes. Just like I and many of my fellow transport medics could probably be trained to function as an ICU nurse. The question is why the push by nurses to move into our field?

Nursing pushes back hard on any attempt to play in their sandbox. Yet they have no problem pushing into medicine, out-of-hospital care. Ect. If you want to know any issue with nursing as a whole I have, it's that.

 

[TatuICU]

I know we bill ours, as do most others that use it in the state, as a specialty transport and it is at a higher rate. That is for if a CCP or RN or RT or Doc comes along. I am not sure of its actually classification designation.

Yep. The best it was explained to me was that there are apparently a certain set of criteria that, if met, the service can bill more. Oftentimes, whatever makes the transport "special" requires a doc, nurse, whatever

 

[TatuICU]

Just like I'm board certified by the BCCTPC in critical care transport medicine?

While most of (not all) of the medicine is similar, the logistics of coming into and transporting a train wreck of a critically ill, technology dependent patient who may or may not have been sub-optimally managed with one or two providers in moving vehicle are vastly different than caring for them in the in-hospital environment. It's an exercise in planning ahead and at times improvisation and knowledge of alternatives. This is where an experienced and knowledgeable transport paramedic (or nurse) is worth their weight in gold.

Could the average ICU nurse be trained to do this competently? Most likely yes. Just like I and many of my fellow transport medics could probably be trained to function as an ICU nurse. The question is why the push by nurses to move into our field?

Nursing pushes back hard on any attempt to play in their sandbox. Yet they have no problem pushing into medicine, out-of-hospital care. Ect. If you want to know any issue with nursing as a whole I have, it's that.

Not sure what you're talking about as it refers to myself as I was a paramedic loooooooong before I was a nurse. Secondly, my reference to board certification was in response to another poster stating that RNs were "jacks of all trades, masters of none."

There is no push that i know of to move into EMS by nursing. I can't imagine anyone in their right mind wanting to work more hours for much, much, much less money and little to no respect, so I'm not sure where that's coming from.

And lastly, nursing pushes back in any attempt to play in their sandbox because they have something that is completely foreign to EMS; competent, cohesive leadership that actually advocates for nurses and protects its profession. EMS does not have that which is why our local medics, regardless of their education , make about 10 bucks an hour and subjects to the whims of the ambulance owners association that takes care to make sure they can work them to death for no money......which is why they leave, usually for nursing. The NREMT is a U-S-E-L-E-S-S organization that does nothing to actually advance EMS as a profession, which is why its in the shape its in now.


Also, in my heart of hearts I think that a lot of this board certification process is just a racket so that these organizations can make money. I just looked up that BCCTPC website and anyone can take that test just so long as they're willing to join the org and pay or not join the org and pay more. Same as with most, but others require letters of reference and audit their candidates.

 

[mycrofft]

Tech versus professional. Sigh.

There are many unprofessional nurses (and doctors, lawyers, school teachers etc), and many many techs who are top-notch professionals. This blurs it.

I have participated in multiple drawn out threads here about the divide between a profession and a technical field. Nursing barely makes the cut as a profession and the more technical it gets the less of a distinct profession it is.

A unique field of research, knowledge and practice; self-governance to a degree; and the ability and expectation to make decisions and direct others based upon this field of knowledge; these are three bedrock elements. Like the difference between a 2nd Lt and a MSgt, which one has the depth of training and the expectation/duty/right to decide and lead?

Prehospital EMS (PEMS) and the use, in abrogation of the NHTSA nomenclature, of Emergency Medical Technicians (B or P) in non-emergency roles, is predicated on protocols based upon medical research, written by (or approved) and enforced by doctors. The ability to self-govern really makes the difference. If the AMA decided today to eliminate the current EMT system, there is a good change that they could really make a dent, whereas there is NO EMT association (NREMT is not) to protect EMT's or take the fight back to offending entities.

If the prep for Paramedic is the same as for nurses and makes them equal, why can't paramedics just take the NCLEX and get that RN tacked on for higher average pay, wider geographic employment opportunities, openings for administrative and research jobs? Because preparation in nursing college (read posts above by nurses) is broader and not just based upon technique. Or at least it shouldn't be. There are cram course and books to study for NCLEX to allow "nursing technicians" (nursing mill grads or nurses from countries where standards are not so high) to get their license who ought not to, in my opinion.

If you aren't a nurse, you do not know what preparation is entailed and what the difference is, but try this: if a paramedic walks into a hospital, can (s)he give a nurse an order? On the other hand, nurses in hospitals often give or pass on orders to techs. A nurse CANNOT accept a second hand/verbal order, but techs customarily do. Professional autonomy.

This sounds like the threads about guns and tattoos; when the advocates are asked pointblank, their response is "You just don't get it, do you?".

Again and again and again: neither specialty is superior, and the people who can't cooperate and are nasty with other care team members for whatever reason (race, gender, certificates, religion, tribal or clan affiliation etc.) need to go play by themselves.

PS use SEARCH