RN to Paramedic...

[NomadicMedic]

Okay. I've had about enough. Any personal attacks or name calling are going to result in forum vacations.

I've removed the off topic posts ... You're all presumably adults. Try to behave accordingly.

 

[Summit]

CriticalCareIFT, please explain how an ICU nurse following standing orders is noctoring, but a paramedic following standing orders is something different?

 

[wanderingmedic]

We are all here to help people who are sick. Can we work together to do that please? Both Nurses and Medics play an important role in patient care, and neither one is better than the other.

If there is anything we in EMS should be encouraging, it is getting other healthcare providers acquainted with our capabilities, scope, and role. This opens the door to better training opportunities and a better integrated healthcare system for our patients.

I'm a huge fan of cross training providers because it provides a more diverse workforce with a larger base of knowledge, and gets more people involved in the different phases of patient care.

Please! Encourage this person to continue their education and get involved in EMS!

 

[Handsome Robb]

CriticalCareIFT, please explain how an ICU nurse following standing orders is noctoring, but a paramedic following standing orders is something different?

That's a great question.

Paraoctoring?

 

[triemal04]

That's a great question.

Paraoctoring?

Paranocturing.

Couldn't resist...:lol::beerchug:

 

[Clipper1]

If there is anything we in EMS should be encouraging, it is getting other healthcare providers acquainted with our capabilities, scope, and role. This opens the door to better training opportunities and a better integrated healthcare system for our patients.

It should be a two way street. Obviously there are some in EMS who have zero clue about what nurses do and there are plenty of discussions on this forum to show this usually in a very negative light. Why should other professions have to know what you do in detail? Also, EMS changes its titles and scope every few years or is vastly different from one area to the next to the point which it becomes absurd to care especially when those in EMS can not explain their titles and scope of practice or how to get certified. We see EMS on TV (fact and fiction), in all types of media and have you featured in parades almost daily or at least weekly. Maybe it is time you also see what others do and see they also have a role in health care.

 

[JPINFV]

If you still got your panties in a bunch regarding internal medicine was for Anesthesia/Critical Care Medicine (CCM) Fellowship program.

That's a pulmonology/critical care fellowship, which is a 3 year fellowship following a 3 year internal medicine residency.

Unlike most specialties (however there are a fair number like this), anesthesiology is a 3 year residency following a 1 year internship. Most specialties incorporate the intern year as a part of their residency. That internship year can be a medicine internship program, surgery internship program, or a transitional internship program.

Also plenty of specialties offer fellowship sub-specialty training besides internal medicine. Toxocology and EMS are two recognized sub-specialties in emergency medicine.

 

[JPINFV]

I am just curious, what do doctors do in those hospitals where RN's run codes, make all the medication decisions, and push the drugs? Man what a sweet gig those places must be for a doctor.

There's this period of time between recognition of a cardiac arrest and the time for the responding physician to arrive at said cardiac arrest. It's generally seen as bad form for the nursing staff to stand around with their thumbs up their butts watching the patient die.

 

[JPINFV]

You really think that a nurse has to go and ask a doctor anytime they titrate a pressor or a paralytic or sedative?

If there's not a standing order (unit protocol, etc) or PRN order... yes. However generally said orders are already formally put into place with a "if lab value X, then increase rate by X and bolus Y).

 

[Clipper1]

If there's not a standing order (unit protocol, etc) or PRN order... yes. However generally said orders are already formally put into place with a "if lab value X, then increase rate by X and bolus Y).

If the patient is on a paralytic you can be pretty sure they are on a ventilator. Modern ICUs have ventilator protocols which have been found much more effective than calling a physician every time. In a unit running 30 ventilators with multiple drips, various gases and different ventilators, no CCM doctor can be everywhere all the time. It has also been shown to hinder patient weaning if RNs wait for doctors to get around to writing orders for every patient which needs to get and not just lay around waiting.

 

[JPINFV]

If the patient is on a paralytic you can be pretty sure they are on a ventilator. Modern ICUs have ventilator protocols which have been found much more effective than calling a physician every time.

Do you want to know how I know you didn't read or understand my post? Hint: We used the same word.

 

[CriticalCareIFT]

That's a pulmonology/critical care fellowship, which is a 3 year fellowship following a 3 year internal medicine residency.

Unlike most specialties (however there are a fair number like this), anesthesiology is a 3 year residency following a 1 year internship. Most specialties incorporate the intern year as a part of their residency. That internship year can be a medicine internship program, surgery internship program, or a transitional internship program.

Also plenty of specialties offer fellowship sub-specialty training besides internal medicine. Toxocology and EMS are two recognized sub-specialties in emergency medicine.

My main point here was to illustrate that a physician was trained to perform physicians job and practice medicine from the start, he was not practicing nursing and then decided to specialize and go into anesthesia. Practicing nursing and practicing medicine are too different things, yet nurses always want to practice medicine and claim they already do so in their nursing roles.

There's this period of time between recognition of a cardiac arrest and the time for the responding physician to arrive at said cardiac arrest. It's generally seen as bad form for the nursing staff to stand around with their thumbs up their butts watching the patient die.

Granted no argument there, however it's far cry from paging code "insert color of your hospital". wheeling the cart over and beginning CPR and waiting for a doc to arrive. How is it equal to field code with paramedic team lead resuscitation and post arrest management?

If due to hospital resources there is a physician shortage or due to geography nurses "run" the code because it takes the doctor 30 minutes to get there, this is certainly not the norm, at least not where I work. To expound of your noctoring medical practice by stating there is no doctors available or they are busy in a hospital out of all places is just plain stupid.


I will leave it at that, as this topic already ran it's course here and I have no intent to further dwell in it.

 

[CriticalCareIFT]

CriticalCareIFT, please explain how an ICU nurse following standing orders is noctoring, but a paramedic following standing orders is something different?

Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.

 

[Clipper1]

Do you want to know how I know you didn't read or understand my post? Hint: We used the same word.

A little sensitive?

You are not the only one who can comment on "protocols" and give specific examples.

The are many, many "unit" protocols as well as disease specific.

 

[Clipper1]

Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.

No, that is not necessarily true. When a patient arrives to almost any unit in the hospital, procols are initiated. Even with admits a physician may not have to see the patient for 4 hours or write orders except to admit.

Paramedics can also call for anything which is not obvious to initiate their protocols. Your protocols are also written in broad terms which are relatively easy to follow. You do not have many known factors to consider which can split protocols into many different pathways. Your protocols are written to take into consideration some of the unknowns which is probably why you use a nonrebreather frequently per your protocol. Nurses are able to order certain labs to enhance their decision making.

Yes nurses do run codes. Following an ACLS flow chart is not that hard to do.

 

[VFlutter]

yet nurses always want to practice medicine and claim they already do so in their nursing roles.

Semantics. Nurses are not unintelligent slaves who blindly follow physician orders. To think they have no involvement or input in practicing medicine is ignorant.

Next time a MD puts in an order for a medication that I think is inappropriate should I just give it? Am I practicing medicine by holding it?

Granted no argument there, however it's far cry from paging code "insert color of your hospital". wheeling the cart over and beginning CPR and waiting for a doc to arrive. How is it equal to field code with paramedic team lead resuscitation and post arrest management?

And how many in-hospital codes have you been involved in? I tend to do a few more things than just start CPR.

If due to hospital resources there is a physician shortage or due to geography nurses "run" the code because it takes the doctor 30 minutes to get there, this is certainly not the norm, at least not where I work. To expound of your noctoring medical practice by stating there is no doctors available or they are busy in a hospital out of all places is just plain stupid.

How do you know what the norm is? How many hospitals have you worked in? How many times have you been involved in a code on a nursing floor? How many night shifts have you worked in a hospital?

I will leave it at that, as this topic already ran it's course here and I have no intent to further dwell in it.

Good. You have proven nothing except that you are totally ignorant to the way hospitals are ran or what RNs do. You have no credibility and no constructive argument.

Because a physician first assessed said patient and gave the orders/standing orders for you to follow henceforth. When a Paramedic arrives on scene sadly there is no doctor there assessing the patient and informing me of the care plan.

We have floor protocols and standing orders that we can use for any patient based off our assessment. This is different than PRN orders put in place by the MD after assessing the patient. Do you think that the MD is the first person to see a patient? Like I have stated before many times I will get verbal orders on patients based off my assessment alone. Do you think RNs can not assess?

I will continue to "Noctor" and provide excellent patient care. I have an excellent relationship with all the MDs I work with and guarantee that they would describe me as a colleague, not a servant.

 

[Jawdavis]

I have to agree with chase. Yes there are many areas of nursing and yes there are many floors that dont require you to have ACLS but when a patient codes or is about to they dont call a team of physicians to the room they call a rapid response team which is usually a few nurses and maybe an RRT. Half of the floors in the hospitals dont have a doctor near them half the time. Yes paramedicine focuses on emergency but nurses, if specialized, can perform these as well. In medicine I dont think that there is one branch that is higher than the other, if we didn't have one group the medical system would collapse.

 

[ExpatMedic0]

Doctors treat and cure diseases/illness, RN's treat patients under direct/indirect orders/supervision. They perform support functions. They certainly do not practice medicine in my opinion

The lowest possible education to obtain an RN licence is a certificate program in a few states(although not many exists any longer) However, for the sake of argument, we will say community college education and an associates degree. The lowest possible education to obtain the title of MD would be medical school.

I think both sides of this argument are a bit extreme, nurses are not mindless zombies and are capable of functioning with out holding a doctors hand for every single thing. However, the nurses are getting defensive. At the end of the day the Doctor is in charge and that is who is practicing medicine, the guy/girl who took a degree in medicine.... Not nursing... or whatever...

If you don't like it, take some initiative and go to medical school, this goes for any and every healthcare occupation, not just nursing. Otherwise, swallow your pride, realize your not the one in charge, get off your high horse and enjoy your career choice of assisting the doctor in whatever capacity you have chosen as a career.

 

[Christopher]

Interested in obtaining my EMT-P. Currently an ER/ICU RN with 7 years experience, EMT-B with 12 years experience. Anyone out there know of a good bridge course that doesn't require me to do 15 months of paramedic school (yawn). I know about the Creighton University 2 week course but I feel that is a bit too quick. Some people have told me to challenge it but I think that is ill-advised. Thanks for any input.

You're likely overqualified educationally for the role as a paramedic. As an RN you'll be lacking on the operations side and probably the "dealing with the street" side...except you're an EMT.

You'll be fine in a 2 week class plus some field time, probably 100 hours or so would be more than enough.

Don't listen to the townfolk who tell you otherwise, your credentials are more than satisfactory. I only wish the folks in my paramedic classes were as well prepared as you are.

 

[epipusher]

As a current student in a Medic to RN program I am most definitely witnessing both sides of this argument.