That's a pretty unfair action consequence, one that shows how little the hospital thinks of paramedics. If a less than steller nurse made a very serious medication error, would you get rid of all nurses form that unit? would they even get fired, or just sent for "retraining?"
Nobody got fired. The timing was such that we were losing our current paramedic staffing in the next few months for various reasons anyway (med school, getting on fire, moving out of state, et cetera), so we simply didn't hire back into the position. The medication issue was largely that it was fully allowed under the state paramedic scope of practice but also was something not really educated on. It really brought into light the risk of using prehospital providers in the ED and the difference in education. Unfortunately since the error would have been deadly had it not been realized shortly after by another staff member there was a very strong reaction by hospital leadership. I'm not entirely sure it was unfair since the state was allowing medics to practice in a way they really weren't educated in.
Had a nurse made the same error there would have been very serious disciplinary action. In fact we actually had an agency nurse make essentially the same error, we no longer allowed her or anyone from that agency (they defended her and didn't acknowledge the serious nature of the error) to work in our ED. I'm not sure what we would do if a staff nurse made that error, we would probably put them on an improvement plan but I'm not really sure if we would allow them to practice at the bedside even on a floor. For the medic it was a training issue, for a nurse it would be negligent care.
Based on my limited observations, 80% of the skills that a nurse does in an ER a paramedic can do. the other 20% the medic can be taught to do, (just like a newbie RN would need to be taught how to do stuff that wasn't covered in nursing school that their facility does or equipment they use). They can be good in the ER, but not so on the rest of the floors.
A paramedic may be able to do 80% of the tasks for ED patients, but the knowledge behind it is very different.
Part of the problem is that the background knowledge and experience of nursing in a big part of keeping the department functioning. I can't expect a medic to understand how to prioritize treatments based on the nature of hospital medicine. I can't have them give off label meds. I can't have them admit patients upstairs. I can't have them make complex discharges.
For example in medic school I had rotations in the ED, it was focused on training for interventions (intubations, starting IVs, reading EKGs, etc) and assessing patients which I then discussed the the docs what I thought could be wrong, if it needed ED evaluation, what field treatments I would give, and so on. In nursing school we teach how to manage the patient's hospital course, how to balance a full load of patients (I've had up to 9 at a time, many of whom we an ESI 2 and the rest 3s, though typically we have far fewer sick patients), and the risks and benefits of the treatments we are giving. I'm not responsible for making medical decisions, but I am responsible for intervening if there is an unsafe decision or one not being made.
Just to emphasize the point I'll compare a few other clinical areas, I do very much realize that it is not the same as the ED.
In L&D as a paramedic student I went from room to room watching and participating with deliveries. In nursing school I took two patients and cared for them for 12 hours through all four phases of labor, or in the perioperative environment when getting a cesarean.
In the ICU and PICU as a paramedic we went around assessing for the various life threatening conditions that landed them in the unit. As an nursing student we did all of their care for 12 hours for 1-2 patients.
In the OR in medic school I went from room to room getting tubes, and watching a few cool procedures. In nursing school we stayed and observed the entire process from preop to pacu.
Psych rotations in both medic school and nursing were equally watch and don't do a whole lot of anything else, although in nursing school we were forced to practice our 'therapeutic communication'.
In paramedic school I never had rotations in community health, school nursing, med/surg or the peds floor. Our pharmacology classes had different emphasis, so did our physical exam classes. Our programs emphasized different patient management goals, and taught two very different ways to view patient care.
From the opposite side of the argument an RN can do 80% of a paramedic straight out of school or with minimal training (with the assumption that they have ACLS and PALS). They take a basic history, perform a physical exam, assess for a medical emergency, place IVs, follow protocol orders for treatment, contact a physician for orders when a presentation is not adequately covered by the protocol, and so on. At least in my state with additional training there isn't actually any paramedic skills that cannot be performed by an RN who has additional didactic and hands on training. RNs can intubate, place EJs, interpret EKGs, et cetera. That doesn't make them paramedics. The training isn't the same, they don't have field internships, and generally would be pretty disastrous.
I think that if we suggested using nurses to cover the ALS shortage that paramedics would be much quicker to point out the difference between paramedicine and nursing.
