Paramedic vs RN
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FiremanMike
Just a dude
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I feel like there’s more to this story.
No we just have a nurse volunteering as a medic and realized I really don’t her scope and what I can rely on her to do it I’m running on a call. For example, they can’t intubate in the hospital, but can they do it on an ambulance?
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Sounds like a discussion to have with them and your medical director.
FiremanMike
Just a dude
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She’s functioning under your medical protocol just like you are. Does she not have any ems certifications at all?
akflightmedic
Forum Deputy Chief
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No EMS certs then she is a First Responder.
Unless your Medical Director has signed off on it, however the MD cannot trump the State's BON, so her license would be at risk for practicing out of scope. Orr if you are in a state where they have prehospital RNs (which is not common and I cannot really speak to).
Unless your Medical Director has signed off on it, however the MD cannot trump the State's BON, so her license would be at risk for practicing out of scope. Orr if you are in a state where they have prehospital RNs (which is not common and I cannot really speak to).
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Are you sure they can't intubate in the hospital? "Not allowed to intubate per their scope of practice as defined by the state BON" and "can't intubate due to hospital policy" are different things.
Scope of practice questions like this depend entirely on state BON and EMS regulations and they are different everywhere. Best place to start is probably your agency medical director.
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You will have to find out if she's officially recognized in some manner by the EMS system. No EMS certs, then she's a First Responder. A very well educated and experienced First Responder, but a FR nonetheless. While I'm also licensed as a Paramedic, if I'm working as a CCT-RN I have to gain formal recognition by local EMS systems to function in the pre-hospital (not IFT) realm. Most of the time I do IFT work but it is possible to be pulled into the EMS system if required and as such, that recognition allows me to function in a similar manner as a Paramedic. Out here in California, CALSTAR used to fly dual RN helos and they were NOT usually licensed at the EMT level or above... however ALL the areas they operated in recognized them as pre-hospital personnel. They followed their own company protocols but those protocols were approved by each area's medical director, and yes, they did intubate/RSI patients as needed. They didn't run afoul of the BRN as they were properly trained and oriented to doing the job and had proper clinical oversight. That being said, it is EASY to get into trouble as an RN when working in the EMS world.
As an RN, my actual scope of practice can be extremely wide. If I have been trained to perform some given advanced skill, I may then perform that advanced skill when it is indicated for me to do so. That includes intubation. In my case, in hospital, I do ultrasound guided peripheral IV insertions. My hospital does NOT authorize me to intubate patients, but if they were to create a standardized (nursing) procedure for it, and I got accredited in that procedure, then I could intubate patients in my hospital and I wouldn't run into a problem with my BRN. If I intubated a patient in my ER job, I would (likely) get fired and investigated by the BRN for exceeding my authorized scope of practice as outlined by my employer... If I were to intubate a patient in my CCT-RN role, even if it was at my hospital's ED, I would not encounter those problems.
Bottom line is that if that RN is (somehow) recognized as a prehospital provider by your local EMS agency, then she's good to go and may practice at the level she is authorized to. It is entirely possible that the EMS Medical Director could determine that she may not do certain skills that Paramedics usually do, or she may be authorized specifically to perform procedures that Paramedics are not usually authorized to do. The risk is mostly on her. You do your job as you are trained and authorized to.
DrParasite
The fire extinguisher is not just for show
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Have you tried, idk, asking her?
She might be an ortho nurse, or a psych nurse, where their prehospital experience is limited... Or she might be an ER nurse or an ICU nurse, where she known more about medicine than you do. There is also state credentialing; does she need to complete an EMT course, or a Paramedic course, to functional as a prehospital provider, as per state regulations?
This sounds like a discussion you should have with her; in all likelihood, she likely already discussed this with your medical director and your agency's leadership already.
MackTheKnife
BSN, RN-BC, EMT-P, TCRN, CEN
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Which state? PA has PHNs who can operate like a medic
NomadicMedic
I know a guy who knows a guy.
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I came here to say this. A Pennsylvania PHRN has the same scope as a Paramedic. Also, NREMT also offers a “professional pathway” for RNs to attain paramedic certification through competency verification and the exam process.
Until you talk to this RN, you have no idea how they got credentialed.
PotatoMedic
Has no idea what I'm doing.
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As others have said every state is different. Idaho has a general ABC license (ambulance based clinician) and their scope is set by the medical director and what they are trained to do.
E tank
Caution: Paralyzing Agent
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You a TV dude? What's this deal in Boise with a bls ambulance and ALS FD squad. Mostly downtown I think...know anything about that?
DrParasite
The fire extinguisher is not just for show
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Home
Ada County Paramedics serves the residents of Ada County as healthcare providers and patient advocates in the 911 system. Learn more today!
adacounty.id.gov
PotatoMedic
Has no idea what I'm doing.
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Not quite. All ambulances (911 specifically) are ALS. Depending on the fire department either some or all the engines have a paramedic on it. They are trialing a BLS ambulance downtown as most of those calls in that area a low level BLS calls per the data and if it is an ALS call the fire paramedic will ride on the box in.
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Wait, they're using actual historical data to determine manning levels? The horror!
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To split hairs, a PA PHRN has a higher scope, when on a state-certified SCT unit.
OP - the answer is complicated - best to simply ask. Some states let RN's function in lieu of a paramedic or to assist a medic - legacy rules from 1970's and before. Several other states have a pathway to an EMS license with a RN license.