Nurses are way better than paramedics

[MagicTyler]

I'm tired of paramedics being looked so down upon by nurses. I work in a busy ER with EMTs, Medics, and RNs. I hate the way that a Paramedic is seen as such a lower level of care than an RN and their observations are taken with a grain of salt. Even our field medics are seen that way. I have the utmost respect for paramedics, and think that a lot of them have just as much knowledge as an RN (especially an associates RN). I wish there was something to do to make our profession equal to that of nursing. Such as a Bachelor's Paramedic program, or a higher level of care in EMS. Does anyone else see this in their communities?

 

[Phlipper]

I wish there was something to do to make our profession equal to that of nursing.

Oh there is, but you wouldn't like it. There's a post or three about it around here somewhere.

 

[rook901]

Guess what? The behavior and thought process you're describing goes both ways. Some nurses hate medics, some medics hate nurses. This will never change until both sides are exposed more to each others' profession.

One thing that was off-putting in your post was the statement, "especially an associates RN". This demonstrates your unfamiliarity with RN education. From a clinical standpoint, the BSN is no more prepared than the ADN. The additional time in the BSN program is a lot of research and management-related education. If Bachelor's became the standard for medics, would you deem the grandfathered-in Associate's or Diploma medics as subpar?

As for medics having "as much knowledge as an RN", you're talking apples and oranges. It's like saying an emergency physician has as much knowledge as a family practice physician. Medics have a deep understanding of one area of medical science - emergency. Nurses have a broader scope, covering many more areas, but with not nearly as much depth.

If you feel that you are being treated unfairly in your clinical practice, you need to start documenting and taking things up the chain of command.

 

[JPINFV]

As for medics having "as much knowledge as an RN", you're talking apples and oranges. It's like saying an emergency physician has as much knowledge as a family practice physician. Medics have a deep understanding of one area of medical science - emergency. Nurses have a broader scope, covering many more areas, but with not nearly as much depth.

I think this is a big thing. Physicians and RNs are educated as generalists, and then following their initial education specialize (for RNs through work CEs and physicians through formal residency programs leading to being eligible for board certification). Physician education in the US is actually kinda of funky because of how health care in the US has evolved since there are very few general practitioners anymore outside of the military. Essentially all primary care physicians are either family practice, internal medicine, or pediatric specialists, in contrast to non-residency trained general practitioners, where as military general medical officers have not necessarily completed residency.

In contrast, current paramedic education produces one trick ponies. Very well trained one trick ponies, but one trick never the less. This makes it more difficult to spread out since any new roles will require considerable education just to cover the basics, whereas physicians and nurses have already been educated in those basics.

 

[Frozennoodle]

I'm tired of paramedics being looked so down upon by nurses. I work in a busy ER with EMTs, Medics, and RNs. I hate the way that a Paramedic is seen as such a lower level of care than an RN and their observations are taken with a grain of salt. Even our field medics are seen that way. I have the utmost respect for paramedics, and think that a lot of them have just as much knowledge as an RN (especially an associates RN). I wish there was something to do to make our profession equal to that of nursing. Such as a Bachelor's Paramedic program, or a higher level of care in EMS. Does anyone else see this in their communities?

From my experiences in the ER doing clinicals' for I-85 I don't see that. The nursing staff there have a lot of respect for Paramedics even though they might complain from time to time about the way an IV is secured or some other tiddly wink thing. I was talking with one nurse in particular who said she has learned a lot from the paramedics that come into the ER.

 

[terrible one]

An RN vs Medic thread?!?!??!?!??!!? No way? Please go on.

 

[abckidsmom]

I totally agree. Nurses are definitely way better than paramedics.

Dana, RN, EMT-P

 

[jjesusfreak01]

From my experiences in the ER doing clinicals' for I-85 I don't see that. The nursing staff there have a lot of respect for Paramedics even though they might complain from time to time about the way an IV is secured or some other tiddly wink thing. I was talking with one nurse in particular who said she has learned a lot from the paramedics that come into the ER.

You have to remember that Nurses and Paramedics do IVs somewhat differently. Nurses IVs are generally completely by the book, very structured, from cleaning the site to securing the catheter. This is in line with the nursing mindset, which is to do them according to policy and like they are trained to do. There is ABSOLUTELY NOTHING WRONG with this (and they may often have little choice). Paramedics are trained in skills, but are expected to adapt to whatever needs to be done at the moment. So long as it works, its good. So, an IV might be taped down a little differently, but as long as the medic can clinically justify their method, no problem. Obviously sloppiness and inconsistency cannot be justified, and EMS personnel should do their best to find the best practices that work for them and follow those (as protocol allows), but that's part of their role and clinical responsibility when they are responsible for patients in the field. Also, nurses are awesome!

 

[rook901]

In contrast, current paramedic education produces one trick ponies. Very well trained one trick ponies, but one trick never the less. This makes it more difficult to spread out since any new roles will require considerable education just to cover the basics, whereas physicians and nurses have already been educated in those basics.

All good points. It drives me crazy when medics talk about how they should be primary care providers, able to write scripts, etc. I'm sorry, but two years of paramedicine education does not cut it for being able to write prescriptions for antibiotics like they're candy. If we could expand the medic education base to be broader in scope so that the medic could function as a generalist, I wouldn't have a problem with medics out there writing scripts and being primary providers. But, honestly, since we're just now getting to a point where we're MAYBE going to have a uniform EMS scope of practice across the nation within the next few years, it's going to be a long road to medics being generalists.

 

[FreezerStL]

An RN vs Medic thread?!?!??!?!??!!? No way? Please go on.

[YOUTUBE]http://www.youtube.com/watch?v=7IU1bzZheWk[/YOUTUBE]

 

[firemedic07]

ya gotta think, now if you were to put a standard nurse in the field they would freeze up because they dont have a doc there to tell them what they can and can not do. as if you would put a medic in the er they would excell. its all about Adapting and overcomming.

 

[Akulahawk]

All good points. It drives me crazy when medics talk about how they should be primary care providers, able to write scripts, etc. I'm sorry, but two years of paramedicine education does not cut it for being able to write prescriptions for antibiotics like they're candy. If we could expand the medic education base to be broader in scope so that the medic could function as a generalist, I wouldn't have a problem with medics out there writing scripts and being primary providers. But, honestly, since we're just now getting to a point where we're MAYBE going to have a uniform EMS scope of practice across the nation within the next few years, it's going to be a long road to medics being generalists.

Sounds like what you're describing is a PA that has specialized in Pre-Hospital and Emergency Medicine...

 

[MrBrown]

Flying doctors with the helicopter emergency medical service are better than RNs

Brown, MBChB, FANZCA, BHSc(Paramedic), BBM

... OK Brown shouldn't lie like that but still, this seems to be a uniquely American phenomina :unsure:

 

[uhbt420]

another nurses vs. medics thread. sigh

as ems education continues to evolve in the us, it will probly move to 2 or 4 yr degrees for medics. right now its more of a military-style training which gives you all the info you need in a single course. the situation will improve with education

at the same time tho, education isn't the whole issue. a rn with a doctorate degree is just another stupid nurse to some medics. walls need to come down

 

[rook901]

ya gotta think, now if you were to put a standard nurse in the field they would freeze up because they dont have a doc there to tell them what they can and can not do. as if you would put a medic in the er they would excell. its all about Adapting and overcomming.

I'm not sure what a "standard nurse" is, but I don't think that you'll find ER or ICU nurses waiting around for "a doc there to tell them what they can and can not do". Additionally, as a medic, the doctor has already told the medic what he can and cannot do. It's called protocol. ICU and ER nurses have the same thing, but it's called standing orders.

This is the reason we have nurses who think that they're better than medics and medics who think that they're better than nurses. Sheer ignorance.

Sure, throw an oncology nurse into an MVC and he's going to freeze up. At the same time, throw a medic into the CVICU and he's going to freeze up. Even throwing a medic into the ER setting is going to freeze him up without a good amount of orientation. To think that you can just take a street medic and throw him loose into the ER and expect that he'll thrive without any additional training and coaching is idiocy. Any time you throw anyone into an environment that they're unfamiliar with, they are going to need time to adapt.

 

[8jimi8]

ya gotta think, now if you were to put a standard nurse in the field they would freeze up because they dont have a doc there to tell them what they can and can not do. as if you would put a medic in the er they would excell. its all about Adapting and overcomming.

im here to represent the faction that would work circles around your 120 hour advanced band-aid class.


Dont speak, unless you speak from experience, because you only show the tiny horizons your mind can imagine.


i'm sorry in, feeding the trolls i become one... btw "o v e r c o m e," that's how you spell it.

 

[djm0219]

To think that you can just take a street medic and throw him loose into the ER and expect that he'll thrive without any additional training and coaching is idiocy.

This is so very true. A friend of mine, who was a medic, recently completed his RN and started working in one of the local EDs. Even after a couple of months he says he is still getting "on his feet" working in the ED and tells us how different it is than when he was in the field.

 

[Journey]

ya gotta think, now if you were to put a standard nurse in the field they would freeze up because they dont have a doc there to tell them what they can and can not do. as if you would put a medic in the er they would excell. its all about Adapting and overcomming.

I doubt if the standard Paramedic could function in the same areas as the RN or even in some EMS or IFT situations without some time to adapt and overcome. I do agree the Paramedic in the ED can excel but as a tech. They are generally supervised by the RNs and restricted even if they use their field protocols because blood products and many of the meds used in the hospital are not part of their scope of practice.

The next time you are in a hospital, ask to see their protocol book which may be online on their intranet or somewhere in the unit or ED. Even for med-surg you will find it is a much thicker manual than what a Paramedic has. It is just in a different set of protocols to cover many, many needs of a patient and not just the emergent ones. There are also specialty teams (Rapid Response and Code Teams) within the hospital who take care of emergencies usually consisting of an RN and an RT which also have many protocols which are similar to a Paramedic but with a broader scope since their operate off Critical Care protocols. This means they also order, do and incorporate lab values into their treatments which a Paramedic does not have the ability to do or the education for unless they are on a flight team and then there is generally an RN with them to provide that part of critical care decision making. But that doesn't mean a Paramedic can't get a degree and learn these things. They however are at a disadvantage because they lack the years of ICU experience working with lab values and all the different meds on a daily basis. Med surg RNs also often run their protocols off lab values. Considering a med-surg or ED RN will have 5 - 12 patients at any given time for the entire shift, they have to do a lot of adapting and overcoming. In the nursing home they may have over 30 patients and 300 medications and therapies to do. A Paramedic usually has only one patient for a short time who may be the only patient for the entire 24 hour shift in some areas. A Paramedic also does not have the education and training to work in an ICU, OR or most areas of the hospital including an ED without an orientation and extra training. Even CCT Paramedics may need RNs to set up all the medications and equipment for them so they can then drive quickly to the next hospital. There are also many medications and equipment that a Paramedic is not qualified for and an RN may have to accompany. You may also not see all the different very INTENSIVE care patients because a specialty team will transport them which will usually consist of RNs.

Some Paramedics who enter nursing programs are also overwhelmed when they hit the clinical situation inside the hospital. They didn't realize how many patients and things the RNs have to be responsible for at one time. They also realize how meticulous the charting must be and that there is little room to make a med error but it is easily made with all the distractions going on in a nursing unit. Correct spelling is important in charting and they usually don't have access to spell check.

There is absolutely nothing wrong with taking physician orders either since many medications required to treat one illness may cause another by damaging another organ. Ever wonder why there are so many dialysis patients?

Nurses IVs are generally completely by the book, very structured, from cleaning the site to securing the catheter. This is in line with the nursing mindset, which is to do them according to policy and like they are trained to do. There is ABSOLUTELY NOTHING WRONG with this (and they may often have little choice). Paramedics are trained in skills, but are expected to adapt to whatever needs to be done at the moment.

This sums up why field sticks should be changed out as soon as possible. RNs are trained and educated to prevent more infections. CMS will no longer pay for a patient getting an infection once inside the hospital. Some Paramedics are told all patients will be given an antibiotic which covers everything and field technique doesn't matter. That again just goes to some relying on street medicine rather than actual education.

When the U.S. Paramedic requires a minimum of an Associates degree across the board for entry, then you can talk about respect as a professional. Right now 6 months of training is a tech. Surgical Techs may require 1 year of training which is longer than many Paramedic programs but they are still techs and very specialized which a Paramedic is not qualified for nor can an RN just jump right into without extra training.

A few impressive life saving skills and protocols in the field are of great value but in no way do the protocols and knowledge of a Paramedic begin to cover all the possible emergencies present even after field treatment that still require identifying and correcting the problem or many problems which caused the emergent situation. Treatment does not stop with what is done in the field. It is very rare a patient will have only one straight forward medical problem. Even the MI which seems to some to be pretty straight forward will have other issues which may have caused a clot which must be corrected. A breathing problem may need much more than an albuterol treatment and a diabetic may need more than just a little glucose.

Regardless of how much education you get right now as a Paramedic, you will still be held to the lowest denominator. However, just having an A.S. or B.S. degree will not make you the same as an RN. Many other professionals such as PT, OT and ST require Masters and Doctorates but they do not claim to be RNs. The professions of OT and PT also have assistants that require a minimum of an Associates degree. They are in no way equal to the OT or PT with higher education and even with a two year degree, they may be viewed much like the CNA is to the RN in the hierarchy of the professional world. The PT and OT assistants also know their two year degree is not equal to RNs or their higher educated professionals but they still serve a valuable purpose. They can be happy and secure with that or they can get more education with another credential. The OR Tech can be happy with their title or they can take the steps to become an OR RN.

 

[Journey]

If we could expand the medic education base to be broader in scope so that the medic could function as a generalist, I wouldn't have a problem with medics out there writing scripts and being primary providers. But, honestly, since we're just now getting to a point where we're MAYBE going to have a uniform EMS scope of practice across the nation within the next few years, it's going to be a long road to medics being generalists.

It took 15 years to get the changes together that will be going into place shortly and they are not major changes by any means.

The question is how long do you want each Paramedic to spend with a patient in the field? Can the EMS agencies afford to have all the diagnostic tools on each ambulance? What about CXRs? Are you just going to write an antibiotic script for pneumonia without knowing if it is pneumonia or CHF or what type of pneumonia to determine the correct antibiotic? Medicine is attempting to be more precise to prevent more resistant strains of bacteria. Medicine is also trying to be very, very careful with all procedures done to prevent more infections or avoid patients needing dialysis for either the short or long term.

 

[SerumK]

I'd like to join the pissing contest. Can someone please tell me where the line we measure from is? I've been drinking all morning!