A Paramedic is not an independent practitioner. Your protocols are orders from your medical director which is no different than what an RN operates by every day in a hospital. Anything not in your protocols you call your med control and/or transport to a hospital to a doctor. The Paramedic TAKES their patient to a doctor who is required to be present in an ED. A nurse in a hospital or long term care facility may not have a doctor present nor should they call a doctor for every little thing. You should as to see their standing orders sometime and be surprised about the decisions they do make. The higher the level of care they provide, the more decisions about initiation of therapy and titrations they are expected to make. Again, most of the decisions concern medications and procedures which are not normally found in the Paramedic's scope of practice.
Looking for some guidance -- RN to EMT-B/Paramedic
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A Paramedic is not an independent practitioner. Your protocols are orders from your medical director which is no different than what an RN operates by every day in a hospital. Anything not in your protocols you call your med control and/or transport to a hospital to a doctor. The Paramedic TAKES their patient to a doctor who is required to be present in an ED. A nurse in a hospital or long term care facility may not have a doctor present nor should they call a doctor for every little thing. You should as to see their standing orders sometime and be surprised about the decisions they do make. The higher the level of care they provide, the more decisions about initiation of therapy and titrations they are expected to make. Again, most of the decisions concern medications and procedures which are not normally found in the Paramedic's scope of practice.
Thanks, I never thought of that route. Mostly, I want to have the knowledge to provide effective and safe care in an emergent field environment -- I have a friend that is a TraumaHawk Medic-RN who went through school with me. I'll ask her what she thinks.
VFlutter
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Unfortunately, there is also inconsistency in nursing education. Not to the same extent but still there. Most BSN schools are AACN accredited and have very specific criteria but outside of that there still a lot of diploma/ADN programs with some very low standards. But with most hospitals moving towards requiring BSNs things have been getting better.
I was just looking trough my transcripts and it really surprised me how many various classes I had to take over the years. I really hope EMS education gets up to speed but as of right now it's not even a comparison.
This is going to sound arrogant but it's an honest question. For the paramedics that say that a nurse should not be able to challenge or bridge, what makes paramedic education so specific to the job that is not covered in my nursing education along with my EMT-B? Yes, they teach you to think differently but it all comes down to critical thinking.
You can also check out Florida Flight 1 at Florida Hospital and Air Care at Orlando Regional.
http://www.floridahospital.com/florida-flight-one
http://orlandohealth.com/orlandoreg...rMedicalSpecialties/AirCareTeam.aspx?pid=4496
It looks like Florida has a lot of nurse lead flight teams and some headliners for pedi and neo transport also with teams that use both ground and air.
Next year you should make a point to attend the Clincon to network.
http://www.emlrc.org/pdfs/clincon2012brochure.pdf
http://www.floridahospital.com/florida-flight-one
http://orlandohealth.com/orlandoreg...rMedicalSpecialties/AirCareTeam.aspx?pid=4496
It looks like Florida has a lot of nurse lead flight teams and some headliners for pedi and neo transport also with teams that use both ground and air.
Next year you should make a point to attend the Clincon to network.
http://www.emlrc.org/pdfs/clincon2012brochure.pdf
Nurses do not come out of school to be fully able to be critical care, OR or wound care nurses either. Some go through more classroom and bedside training in their specialty which is longer than many Paramedic programs. But, they have an extensive base which gives them the ability to specialize with knowledge along with skills with confidence. It is too bad the US Paramedic education does not have the preparation such as other countries where the educaiton is also emphasized and where the pissing matches that because someone can intubate they must be the superior professionals are eliminated.
The Paramedic programs focus on skills rather than the whole package. Intubation and RSI is a big deal for a Paramedic in some places. But, an RN must be comfortable with an intubated patient to manage the drugs and the ventilator for 12 hours beyond just the intubation which take a few minutes. It takes longer to decide whether the NP, PA, Transport RN or RT will intubate with their polite courtesies than it does to actually perform the skill with the RN doing all the prep work for meds and equipment.
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One, independent practice (yes, it is what we do). An ICU RN is probably well accustomed to it. A LTC or floor RN is not. At the moment we aren't particularly interested in how the patient's poor social support system led to impaired gas exchange. Rather, we're interested in treating the presenting pneumonia with appropriate resuscitation measures (yes a bit of hyperbole).
Two, logistics. I'll let everyone in on a secret. Nurses, medics, and even *gasp* RRTs don't have a particularly unique set of medical knowledge. In fact the overlap is staggering. What they all have is a different view pf how to accomplish a given goal. The logistics of doing things like packing up a post ROSC patient to move are where paramedicine earns its keep.
Finally, it's a point of professional pride. I don't go stomping around the hospital playing in their bailiwick. Nurses don't need to micturate in my sandbox. To have my own arrogant moment, I have no doubt with a bit of studying I could pass the NCLEX. BFD, it's an entry exam. Doesn't mean I'm worth what a well educated nurse is. Similarly, because a nurse can pass an entry exam doesn't mean they're prepared to make the call on continuing CPAP or performing an intubation. "Assisting in" and "pulling the trigger on" are entirely different.
EMS doesn't always have a lot of professional pride, but damnit we've got to start somewhere.
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VFlutter
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I totally agree however I still do not see the justification that an RN could not very quickly learn those skills without taking an entire paramedic class. Do you think most new medics are prepared to take care of true critical care patients?
The comment about bedside training is very true. The ICU position I applied for requires a 1 year internship for new grads. 3 months classroom before ever touching a patient, 6 months with a preceptor before working alone and 3 months working with limited patient assignments before being fully allowed to work on your own.
Independent practitioners are NPs and PAs. Paramedics are not. They do not have DEA numbers or write prescriptions.
LTC RNs may be in charge of 100 patients and many of them might be on ventilators. How many decisions do you that than RN must make each shift to keep the patient from returning to the hospital. Doctors and hospitals will no longer be paid if their patient returns too soon which places a larger responsibility on the RNs and the LVNs caring for those patient.
Nurses do assume the responsibilty of CPAP/BiPAP and ventilators in many EDs, ICUs, LTC facilities and home care everyday. Chances are they do receive much more training than a Paramedic on these devices. If a nurse does intubation they usually take it seriously and will get x amount of hours of training in and their profession will expect competencies. Isn't that a big issue with EMS? Some Paramedics only intubate manikins in their programs and then get maybe one intubation a year which may or may not be successful.
If you have actually watched a procedure being done over 200 times, over and over such as an ICU or ED RN, it is not that difficult if you are given the opportunity to train for it. Paramedic student may never have seen an intubation or cric on a real patient but are expected to perform after a video and a few passes at a manikin.
Your lack of respect for nurses stands out. But, I don't think you even have an Associates degree on your resume but you stand critical of anyone who does and attempts to care for many patients at one time which you may have next to no experience in. Your post also shows you don't care for other professionals like RRTs which no one has even mentioned.
EMS has a lot of issues. You have to give nursing credit for knowing how to prepare their nurses for a specialty. Paramedic is supposed to be a specialty but yet so many are failing at the basic skills but make up for it by attacking professions which acheive education first and then the skill.
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VFlutter
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I think we are comparing apples to oranges. Just like everything else there are good and bad providers but I am referring to a very specific group since almost all programs require ICU experience. I would never try to argue a new grad nurse or hospice nurse would or should be able to challenge the paramedic exam. And I have no doubt you would pass the NCLEX, it's not difficult.
The problem is you can't write rules for the top 10%, or for that matter, the bottom 10%. You've got to try to cover the 80% in the middle.
Now if the US Paramedic was more like this....
http://www.abc.net.au/news/2012-08-...uipped-to-be-first-responders3a-union/4196992
Their education:
http://www.ambulance.vic.gov.au/Paramedics/Become-a-Paramedic/University-Courses.html
Imagine the fuss that would be raised here in the US.
VFlutter
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Just for comparssion here is a copy of my transcript. I would say it is pretty typical for most BSN programs. 4 years, 108 credit hours
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On the same note there are Paramedics wearing the patch who have not started IVs, intubated or pushed any meds for months or even years. They might be one of 3 - 6 responding Paramedics. They might only do IFT. They might work a very slow station. They might have a hospital on every corner within a few blocks of all of their calls. They are still given the same status as a Paramedic unlike nurses who get labeled by Paramedics for what they perceive to be a "lack of skills" rather than for what they know or the skills they can do even if they aren't the headline grabbing ones. It is due to the skills and knowledge of nurses in some areas like LTC which keep patients from needing the more heroic skills
Similarly there are "CCRNs" who haven't worked bedside for years in management positions. We can find turds everywhere. Why are you intent on bringing up every prehospital shortcoming?
Until you start to see where EMS can improve it never will. You want a broader scope of practice and fail to see where education must be included. Until you do that, YOU penalize every Paramedic who has done the seat time to get at least an Associates degree. Take note of how other professions have moved past the pettiness of I can do everything someone else can and didn't need no education to do it. Just because Texas allows you to do anything you want with only 600 hours of training does not mean it is right or should be the standard.
At least with the CCRN title, they did put in some time in the ICU for the CCRN age specialty test to qualify. They also must take the CEs to maintain it.
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I'm well, well aware of the shortcomings of EMS education. Rather than take potshots on the internet I spend 3-4 days a week trying to actively educate paramedics in addition to a full time schedule on a unit. And I'm willing to put my real name behind my work and views, rather than any number of aliases. When was the last time you did anything to improve the situation?
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Why don't you make Vene post his real name? You might be very surprised.
Why don't you make everyone here post their real name?
There are forums where we do post our names and you aren't on them? Why not? Why aren't you on some of the profedssional forums which require membership? What do you do to support education? A weekend cert doesn't count.
Aidey
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Vene's name is well known to some of us. Along with his involvement in international and stateside medicine. Are you trying to imply that somehow that is all fake? Because that would make him the purveyor of the most impressive fake internet persona in existence I think.
Actually I know his real name.
I educate. A lot. I run QA for a decent sized service. I'm involved in local level EMS committees.
What professional forums would you be speaking of? And I ask again, what have you done to help fix the situation you so hate lately?
Check the other forums for the past 7 or 8 years.