Replacing EMS with nursing revisited

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Veneficus

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A few times in the past, I suggested that it might provide better care providers if nursing were to move into and take over EMS.

After reading about how new grad nurses are having trouble finding employment here on the forum, as well as the absolute objections of US EMS to move beyond simpleminded tech skills, I was thinking it might be time to once again look at the benefits nursing can bring.

Because they already have a general educational base in healthcare and already have practicioners functioning in home healthcare, home dialysis, wound care, etc. They already have the knowledge and skills to provide the service that will be the basis of future EMS as I see it, in commnity outreach and home care.

A "bridge" aka EMS specialty course could easily be added to their education. Much easier than a clinical science background to EMS providers.

Many physicians I have met in Europe start out working in EMS at least part time. As a result when they move back into the hospital they have a great range of skills and insight on patient behavior, conditions, etc. (not to mention the skills to handle emergencies) we could get that same thing from nursing. That might mean a whole generation of nurses who know how to recognize and react to emergencies in any environment they work. No more nursing homes without a clue.

It would provide ample employment opportunity and advancement to qualified nurses as well as new grads. I can't say for sure, but if I would think a new nursing grad would be more inclined to work in EMS if it included preventative care than sit on unemployment. Plus there is a safety built in. Online medical control and the ability to transport.

As I understand, the principle of nursing was to help patients take care of thier basic human needs. Today that certainly includes help navigating the healthcare system as well as a healthcare provider that reaches out instead of making patients come to the ivory tower.

Educational problem solved. EMS advancement problem solved. New nurse employment problem solved. I am king!

Clara Barton was a nurse.
 
So, what say you about places like NZ, UK, AU that have Paramedics, and I use this term gritting my teeth, "on par" with nurses? Should the nurses 'take over' EMS there as well?
 
Linuss said:
So, what say you about places like NZ, UK, AU that have Paramedics, and I use this term gritting my teeth, "on par" with nurses? Should the nurses 'take over' EMS there as well?
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Why fix something that isn't broken?
 
As long as you're open to Paramedics replacing nurses in the trauma room... or cardiology... or respiratory.
 
Linuss said:
As long as you're open to Paramedics replacing nurses in the trauma room... or cardiology... or respiratory.
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As soon as paramedics require a 4 year degree in basic and clinical sciences, I will support them going into any area of healthcare.

But they have had more than ample opportunity and not only do they refuse to take it, more than 90% of them fight against it.
 
Veneficus said:
But they have had more than ample opportunity and not only do they refuse to take it, more than 90% of them fight against it.
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Proof?



Hey, you're always advocating evidence based medicine here :P
 
Linuss said:
Proof?



Hey, you're always advocating evidence based medicine here :P
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check out the percentage of EMS provided by the US fire service.

Also look at the position statements and actions from its leaders like Gary Ludwig.
 
My initial EMS training was a 9 month paramedic class in 1999. I was a year out of nursing school, working in a level I trauma center's STICU. We met on Tuesdays for 6 hours of lecture, and had the minimal clinicals that were part of the curriculum at that time.

I felt that paramedic class did not require much effort, academically, and because I'd been working in EMS for 4 years at that time, I didn't feel that I learned a whole lot practically speaking either.

I've always maintained that being a nurse has made me a much better medic than I would have been otherwise. Even though I've never worked as a nurse in the community where I do EMS, I am much more aware of the resources available to patients, more willing to work the "helping people take care of their basic needs" part of the job than the medics I work with, and having the basic education that allows me to learn about more in-depth topics by reading articles, etc.

My husband has been in EMS a little bit longer than me, and has trained as a firefighter/paramedic through the same initial educational process as I did. He's worked continuously in the field, while I've been out for maternity leave, barely active for about 5 out of the last 8 years.

He still calls me if he runs into something he doesn't quite understand, if he has a good tricky medical call, I *always* have something to say about the patient that he hadn't thought of, and we always end up learning from the discussion. I consider him to be one of the good medics. Since I don't even consider myself one of the best thinkers in the conversations here, I believe that points very clearly at the faults of the system in our country.

The good, *thinking* nurses in ERs and critical care run about 40% of the total population of nurses in those environments. In EMS, the good, *thinking* medics run about 10%. Just to get that ratio a little closer would be great.

This is a radical idea, Vene. I wonder what the ANA would say about it? Could nursing as a whole stand to have a branch of nursing having that level of autonomous practice?
 
We already have that autonomy in ICU. Our protocols and guidelines function very much like standing orders. Open heart starts flagging and pacer wires are still in place. you can bet your hiney i'm going to start that pacer before I make the phone call. Isn't that close to what the situation in California is? Critical Care nurses giving orders to medics over dispatch?


Vene i think this idea is outstanding. Seriously you killed two birds with one stone on that one. It has long been a notion I have endorsed that all RNs get at least an EMT-B.

Linuss (i'm not trying to call you out and be a ****) part of the proof is patch factory medics. For being one of the strongest advocates for education and autonomy of Medics, i can't see why you haven't gone back to school. For arguing so much of the equality of the two professions, wouldn't you agree you need more school to be the equivalent that you defend?
 
I've often thought about this as well. Wont ever happen tho,

Fire Union to strong to allow their "medics" to go back to being First Responders.
Nursing Union to strong to allow their nurses to go out and make just above minimum wage on a box.

While the patient might ultimatley benefit from this (more advanced care, less pt's to the ER, reducing oversaturation, more long term treatments) there are far too many politics in the way. Also who would pay for it? Since medicare is the biggest payer to private ambulance companies how do you justify an RN who can make upwards of $60k in a hospital setting to go work for $30k in an ambulance?

The way I see it more FDs take over emergency transport companies more protocols get diminshed and eventually a paramedic in the US will be able to do little more than an IV and Oxygen.
A perfect example is Los Angeles County the birthplace and the way things are going the death of pre hospital care. Since it's beginning almost 40 years ago paramedics could not do anything without talking to base. What's changed in 35 years? You have a protocol sheet one page long with about 10 drugs you are allowed to use without talking to "mommy". but do any of the 3500 paramedics in LA care? No, because they are making big bucks pulling hose and throwing ladders. Even though 80% of their calls are for medical aides they still call themselves a "Fire Dept" and refuse to perfect and become proficient at basic pre-hospital care.

Oh well...
 
Nurses taking over EMS would have the potential to make EMS more than just a fast ride to the hospital. You're going against tradition. It will never happen.
 
Sasha said:
Nurses taking over EMS would have the potential to make EMS more than just a fast ride to the hospital. You're going against tradition. It will never happen.
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Especially against a FD. They are all about tradition to the detriment of the patient.
 
8jimi8 said:
We already have that autonomy in ICU. Our protocols and guidelines function very much like standing orders. Open heart starts flagging and pacer wires are still in place. you can bet your hiney i'm going to start that pacer before I make the phone call. Isn't that close to what the situation in California is? Critical Care nurses giving orders to medics over dispatch?
Click to expand...

This is different, IMO, than the managment of an ICU patient. Those patients are established, have a team of physicians, and have a sheath of orders. You notice the patient's decline, you use your brain and get a set of labs, replace lytes, adjust the vent and turn on the pacer, but even though it's autonomous, it's not the same as being dispatched, arriving on the scene of a call, and dealing with the patient start to finish.

I see that the arrival at the ER would be much more seamless if this was the case.
 
With a minimum educational entry, that would be a great reason to bump up that pay to something like 42-44 where alot of new grad nurses start. 21 bucks an hour to save another life. Hell that beats 11 an hour where I see my medics hopping from job to job to live.
 
Sasha said:
Nurses taking over EMS would have the potential to make EMS more than just a fast ride to the hospital. You're going against tradition. It will never happen.
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So what about Usalfyre / my agency? What about agencies such as Wake County, Austin/Travis County, Williamson County, Cyrpress Creek and all the other renowned agencies who actually promote their medics to be care providers and not just rides? Who put patient well-being and care infront of revenue?



8jimi8 said:
Linuss (i'm not trying to call you out and be a ****) part of the proof is patch factory medics. For being one of the strongest advocates for education and autonomy of Medics, i can't see why you haven't gone back to school. For arguing so much of the equality of the two professions, wouldn't you agree you need more school to be the equivalent that you defend?
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I had been planning on going back to school after I got my medic for quite a while, but had put it off when I was doing IFT because I knew I wasn't going to stay at that company more than 6 months, and as such didn't want to buy a new place / start college before I got to an agency that I was going to spend some time at. Now that I'm at an agency that I can see staying at for some time, I'm actually back into looking at classes. My first mission is to find a college that will give me life credit for my Paramedic cert so I can finish my EMS degree, to which I've found a few, then move on to either my BA or do an RN bridge.

But like I said, the first step was actually getting settled in to a place to start school again. There was no intention at just staying a certified medic and not moving up to Licensed Paramedic.
 
8jimi8 said:
With a minimum educational entry, that would be a great reason to bump up that pay to something like 42-44 where alot of new grad nurses start. 21 bucks an hour to save another life. Hell that beats 11 an hour where I see my medics hopping from job to job to live.
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You're expecting people who can't grasp why 110 hours of education is not enough to provide adequate care to think long term rather than their intial knee jerk reaction against more education.

There are many people who feel the educational requirements for a Paramedic as is, is acceptable. It's worked thus far, why should you improve it? They'd rather whine and get more money for nothing.
 
If nurses wanted to ride on an ambulance, they would have gone to paramedic school.

It won't work because I have a feeling the majority of them will not want to do it.

I am an advocate of nurses in the pre hospital setting, I have worked pre hospital with nurses before and continue to do so. I have nothing but respect for them and their knowledge, and I feel they respect me and my knowledge (granted I don't fall into the category of most average paramedics.)

In my opinion, the transition of paramedics to nursing (with the appropriate training) seems to be more successful than nurses transitioning to the paramedic role. Keep in mind, I am not just talking about the actual attainment of the certification, but also the practical application of the skills and abilities required for the position.

The thing that makes most nurses successful when they enter flight medicine of critical care transport is many years of experience and gradual increase in education beyond initial certification (the sa,e things that make a medic successful also.)

Taking all of this into consideration, putting GNs in the field is a bad idea. No experience, probable lack of desire, and lastly a real lack of relevant experience for the GNs who want to enter the clinical setting (except for ER and possibly ICU, which is a portion of the overall nursing workforce.)

Remember, we always talk about skills do not equal education. The opposite is also true, education does not equal skills.
 
So what about Usalfyre / my agency? What about agencies such as Wake County, Austin/Travis County, Williamson County, Cyrpress Creek and all the other renowned agencies who actually promote their medics to be care providers and not just rides? Who put patient well-being and care infront of revenue?
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The exception, not the rule.
 
Linuss said:
So what about Usalfyre / my agency? What about agencies such as Wake County, Austin/Travis County, Williamson County, Cyrpress Creek and all the other renowned agencies who actually promote their medics to be care providers and not just rides? Who put patient well-being and care infront of revenue?





I had been planning on going back to school after I got my medic for quite a while, but had put it off when I was doing IFT because I knew I wasn't going to stay at that company more than 6 months, and as such didn't want to buy a new place / start college before I got to an agency that I was going to spend some time at. Now that I'm at an agency that I can see staying at for some time, I'm actually back into looking at classes. My first mission is to find a college that will give me life credit for my Paramedic cert so I can finish my EMS degree, to which I've found a few, then move on to either my BA or do an RN bridge.

But like I said, the first step was actually getting settled in to a place to start school again. There was no intention at just staying a certified medic and not moving up to Licensed Paramedic.
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I didn't figure so, Bro, I just never knew what your plan was.
 
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